Economic analysis of surgery and biological therapy for chronic rhinosinusitis with nasal polyps.

BACKGROUND: Chronic rhinosinusitis with nasal polyps (CRSwNP) imposes major health and economic burdens. Endoscopic sinus surgery (ESS) and biologic therapy are treatment options. This study compares their effectiveness and cost-efficiency from the Spanish National Health System (NHS) perspective. METHODOLOGY: An economic evaluation was conducted in severe CRSwNP, following Spanish-NHS guidelines. Data came from a tertiary-hospital with 10-year projections. Effectiveness was measured as reduction in the Sinonasal Outcome Test-22 (SNOT-22). Cost-utility analysis used quality-adjusted life years (QALYs). Micro-costing was applied for ESS, while annual drug costs were considered for biologics. Sensitivity analyses tested robustness. RESULTS: 89 patients were included (63 ESS, 26 biologics). After 2-years, both strategies achieved similar SNOT-22 improvements (-31.8 ESS, -31.0 biologics). Costs were far lower for ESS (€5,302.78) than biologics (€27,198.23), making biologics less efficient despite comparable benefit. The 2-year incremental cost-utility ratio (ICUR) for biologics was €1.2 million/QALY, above accepted thresholds. At 10-years, biologics yielded 2.75 QALYs at an incremental cost of €108,917.62 (ICUR €39,592/QALY). Sensitivity ana-lyses showed that biologics generally remained above commonly accepted willingness-to-pay thresholds, although substantial price reductions (up to 40%) allowed ICURs to approach the upper limit of acceptability. CONCLUSIONS: Both treatments provide meaningful improvement. ESS remained the less costly strategy and was more efficient over the short term, whereas long-term projections showed higher QALY gains with biologics at substantially greater cost. Within Spanish- NHS, biologics may approach cost-effectiveness only under favorable pricing assumptions and should be reserved for patients with contraindications or persistent disease after ESS.