Cost–utility analysis of dupilumab compared with endoscopic sinus surgery in patients with chronic rhinosinusitis with nasal polyps. Evaluation in Colombia, a developing country

ABSTRACT

Introduction

Chronic rhinosinusitis with nasal polyps (CRSwNP) compromises respiratory function, sleep, concentration, work capacity, and quality of life, generating high costs for patients and health systems. The aim of the study was to analyze the cost utility of Dupilumab compared to endoscopic sinus surgery for patients with CRSwNP.

Research design and methods

We developed a model-based cost–utility analysis from the perspective of the Colombian health system to compare Dupilumab vs. endoscopic nasal surgery in patients with difficult-to-treat CRSwNP. Transition probabilities were extracted from the published literature about CRSwNP, and costing was based on local tariffs. We performed probabilistic sensitivity analysis for outcomes, probabilities, and costs (10.000 Monte Carlo simulations).

Results

The cost of dupilumab ($ 142.919) was 7.8 times higher than nasal endoscopic sinus surgery ($ 18.347). In terms of quality-adjusted life years (QALYs), surgery generates better results than Dupilumab: 11.78 vs. 9.05 QALYs.

Conclusions

From the perspective of the health system, endoscopic sinus surgery for the management of CRSwNP is a dominant alternative in all the analyzed scenarios compared to the use of Dupilumab. From a cost–utility point of view, the use of dupilumab should be considered when the patient requires multiple surgeries or when there is a contraindication for surgery performance.

KEYWORDS:

• cost
• dupilumab
• monoclonal
• polyp
• rhinosinusitis
• sinusitis
• sinus surgery
• utility

Acknowledgments

We thank the University of Antioquia for its financial support. This work was the degree work of doctors L Alvarez and J Querubin for specialization in Economic Evaluation of Health, for which we thank the professors of the Faculty of Economics and Medicine who contributed to their training process.

Declaration of interest

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

L Alvarez, J Querubin, and A Mejia were involved in the conception and design; L Alvarez, J Querubin, J Bedoya, and J Sanchez did analysis and interpretation of the data. All authors approve the final version of the article to be published; all authors agree to be accountable for all aspects of the work.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/14737167.2023.2196407

Additional information

Funding

This project was financed by the University of Antioquia (Medellín – Colombia).