Health state utility values in patients undergoing endoscopic sinus surgery

Abstract

Objectives/hypothesis: The primary study goal was to measure health state utility values in patients with chronic rhinosinusitis (CRS) before and after undergoing endoscopic sinus surgery (ESS). A secondary goal was to assess the meaning of these values by comparing them with other chronic disease processes and currently available medical or surgical treatments.

Study design: Prospective, observational cohort study.

Methods: Adults with CRS were enrolled after electing ESS and were observed for a 5-year period. Baseline demographic and medical comorbidities were recorded for each patient, as well as findings from computed tomography (CT), endoscopy, olfaction, and disease-specific quality of life scores. Utility values were derived using the Short-Form 6D (SF-6D) at baseline and again after surgery.

Results: The mean SF-6D utility value for the baseline health state of all patients with CRS (n = 232) was 0.65 (95% confidence interval [CI]: 0.63-0.66). Baseline utility values correlated with disease-specific quality of life as measured by the Rhinosinusitis Disability Index (r = -0.660; P < .001), but not baseline CT, endoscopy, or olfactory scores. Follow-up utility values (≥ 6 months) after ESS improved by 0.087 (95% CI: 0.06-0.12; P < .001) in patients with no history of sinus surgery and 0.062 (95% CI: 0.04-0.09; P < .001) in those undergoing a revision procedure.

Conclusions: Patients with CRS who failed medical therapy and elected to undergo ESS reported health state utility values that were significantly lower than the US population norm. Utility values showed improvement after ESS, which was statistically and clinically significant. These results provide the initial data necessary for formal cost-effectiveness analyses incorporating ESS.

Trial registration: ClinicalTrials.gov NCT00799097.

Conflict of interest statement

Financial Disclosure Information: There is no conflict of interest or financial disclosure for Eve Wittenberg, MPP, PhD;

Copyright © 2011 The American Laryngological, Rhinological, and Otological Society, Inc.

Figures

FIGURE 1

Correlation between utility value and CRS disease severity measures. SF-6D = Short Form 6D; RSDI=Rhinosinusitis Disability Index; CT=computed tomography; SIT=Smell Identification Test.

FIGURE 2

ESRD=end stage renal disease; HD=hemodialysis; mod=moderate; meds=medications; CAD=coronary artery disease; PCI=percutaneous coronary intervention; CHF=congestive heart failure; COPD=chronic obstructive pulmonary disease; US=United States.

FIGURE 3

PD=Parkinson’s disease; CPAP=continuous positive airway pressure; TNF=tumor necrosis factor alpha.