Endoscopic polypectomy in the clinic: a pilot cost-effectiveness analysis Rudmik, L.,* † Smith, K.A.* & Kilty, S. ‡§ *Division of Otolaryngology – Head and Neck Surgery, Department of Surgery, † Institute of Public Health (IPH), University of Calgary, Calgary, AB, Canada ‡ Department of Otolaryngology – Head and Neck Surgery, University of Ottawa, § Ottawa Hospital Research Institute (OHRI), Ottawa, ON, Canada Accepted for publication 31 May 2015 Clin. Otolaryngol. 2015, 00, 000–000 Objective: The purpose of this pilot economic evaluation was to assess the cost-effectiveness of the endoscopic polypectomy in the clinic (EPIC) procedure compared to formal endoscopic sinus surgery (ESS) for the treatment of select chronic rhinosinusitis (CRS) patients with nasal polyposis. Design: Cost-effectiveness analysis using a Markov deci- sion tree model with a 30-year time horizon. The two comparative treatment groups were as follows: (i) EPIC and (ii) ESS. Costs and effects were discounted at a rate of 3.5%. A probabilistic sensitivity analysis was performed. Setting: Economic perspective of the Canadian govern- ment third-party payer. Participants: CRS patients with nasal polyposis who have predominantly isolated symptoms of nasal obstruction with or without olfactory loss. Main outcome measures: Incremental cost per quality adjusted life year (QALY). Results: Over a time period of 30 years, the reference case demonstrated that the ESS strategy cost a total of $21 345 and produced 13.17 QALYs while the EPIC strategy cost a total of $5591 and produced 12.93 QALYs. The ESS versus EPIC incremental cost-effectiveness ratio was $65 641/ QALY. The probability that EPIC is cost-effective compared to ESS at a maximum willingness-to-pay threshold of $30 000 and $50 000/QALY is 66% and 60%, respectively. Conclusions: Outcomes from this study have demon- strated that the EPIC procedure may be a cost-effective treatment strategy for ‘select’ patients with nasal polyposis. Data from this study were obtained from a small pilot trial, and we feel the results warrant a future randomised controlled trial to strengthen the outcomes. Chronic rhinosinusitis (CRS) is a prevalent condition that causes significant morbidity. 1 Without treatment, a patient affected by CRS is subject to significant impairment of their quality of life (QoL) 2 and a subsequent decrease in work and life productivity. 3 Commonly, initial treatment focuses on topical and systemic medical therapies 4 and failing these, surgery is then considered. 5–7 Traditionally, endoscopic sinus surgery (ESS) in an operating room has been offered as the surgical option. However, an initial report has shown that endoscopic polypectomy performed in the clinic (EPIC) for ‘select’ CRS patients with polyps can provide a dramatic improvement in symptomatology, with high patient satis- faction and for one-sixth the institutional cost of ESS. 8 During the EPIC procedure, a patient is appropriately decongested and topically anesthetised in the office and all polyps within the nasal cavity, middle meatus and spheno- ethmoidal recess are removed with a microdebrider. There is no sinus dissection within the middle meatus during EPIC and all constant landmarks, such as the uncinate process and anterior face of the ethmoid bulla are maintained. Value in health care is defined as the amount of patient outcomes achieved per dollar spent. 9 To improve the overall efficiency of the healthcare system in Canada, there is a call for physicians to begin developing innovative solutions to deliver higher value care. 10 Increasing the value of an intervention can occur with reducing costs while keeping effectiveness the same, increasing effectiveness while keeping costs the same, or a combination of both. From the perspective of the Canadian government payer, the EPIC procedure has an estimated cost of $450 (CAD) in comparison with ESS, which has an estimated cost of $3500 (CAD) per case. 8,11 Although EPIC is associated with a lower cost, it is unknown whether or not this procedure will provide increased value for money as the difference in effective- ness must be considered. Given the current economic environment and the need to develop innovative healthcare delivery strategies that increase the value of care, the purpose of this study was to Correspondence: L. Rudmik, Division of Otolaryngology – Head and Neck Surgery, Department of Surgery, University of Calgary, Foothills Medical Centre, South Tower suite 602, 1403 – 29th Street, Calgary, AB, Canada NW T2N 2T9. Fax: +1 403 210 8435; e-mail: Lukerudmik@gmail.com © 2015 John Wiley & Sons Ltd  Clinical Otolaryngology 1 ORIGINALARTICLE