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Reprinted by permission of Int Forum Allergy Rhinol. 2015; 5(11):1018-1027.

OR I G I NAL ART I CLE

Health utility outcomes in patients undergoing medical management for chronic rhinosinusitis: a prospective multiinstitutional study Lauren J. Luk, MD 1 , Toby O. Steele, MD 1 , Jess C. Mace, MPH 1 , Zachary M. Soler, MD 2 , Luke Rudmik, MD, MSc 3 and Timothy L. Smith, MD, MPH 1

Background: A health utility value represents an individ- ual’s preference for living in a specific health state and is used in cost-utility analyses. This study investigates the im- pact of continuing medical therapy on health utility out- comes in patients with chronic rhinosinusitis (CRS). Methods: The Medical Outcomes Study Short Form- 6D (SF-6D) questionnaire was administered to patients prospectively enrolled in a longitudinal study examining treatment outcomes for CRS. Patients were prescribed ro- bust, initial medical therapy and then elected to continue with medical therapy (n = 40) or undergo endoscopic sinus surgery (ESS), followed by medical therapy (n = 152). Pa- tients observed through treatment crossover to ESS were also evaluated (n = 20). Health utility values (SF-6D) were generated at baseline, 6-months, and 12-months follow-up for both cohorts and evaluated using repeated measures analysis of variance (ANOVA). Results: Treatment crossover patients were found to have a significantly higher prevalence of previous sinus surgery compared to medical management ( χ 2 = 6.91; p = 0.009) and surgical intervention ( χ 2 = 8.11; p = 0.004) subgroups. Mean baseline utility value for the medical therapy co- hort was significantly be er compared to the ESS cohort

(mean ± standard deviation; 0.76 ± 0.12 vs 0.70 ± 0.15; p = 0.023). Significant improvement in health utility was re- ported in the ESS cohort (F (2) = 37.69; p < 0.001), whereas values remained stable, without significant improvement, in both themedical therapy cohort (F (2) = 0.03; p = 0.967) and treatment crossover cohort (F (2) = 2.36; p = 0.115). Conclusion: Patients electing continued medical manage- ment report be er baseline health utility compared to patients electing ESS. Patients electing ESS show signifi- cant improvement in health utility, whereas those electing continued medical management demonstrate stable health utility over 12 months. C 2015 ARS-AAOA, LLC. Key Words: sinusitis; endoscopy; chronic disease; quality of life; ther- apeutics; medication therapy management; utility; health utility; cost-effectiveness How to Cite this Article : Luk LJ, Steele TO, Mace JC, Soler ZM, Rudmik L, Smith TL. Health utility outcomes in patients undergoing med- ical management for chronic rhinosinusitis: a prospec- tive multiinstitutional study. Int Forum Allergy Rhinol. 2015;XX:1-10.

O ne of the primary factors driving health reform in the United States is the unsustainable yearly increase in healthcare expenditure, currently estimated to be 4%

1 Division of Rhinology and Sinus/Skull Base Surgery, Oregon Sinus Center, Department of Otolaryngology–Head and Neck Surgery, Oregon Health and Science University, Portland, OR; 2 Division of Rhinology and Sinus Surgery, Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston, SC; 3 Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada Correspondence to: Timothy L. Smith, MD, MPH, Oregon Health and Science University, Department of Otolaryngology–Head and Neck Surgery, Division of Rhinology and Sinus/Skull Base Surgery, Oregon Sinus Center, 3181 SW Sam Jackson Park Road, PV-01, Portland, OR. 97239; e-mail: smithtim@ohsu.edu Funding sources for the study: NIH (National Institute on Deafness and Other Communication Disorders [NIDCD]: R01 DC005805 to T.L.S., R03 DC-013651 to Z.M.S.). Potential conflict of interest: T.L.S., J.C.M., and Z.M.S. are supported by a grant from the NIH (National Institute on Deafness and Other

Communication Disorders [NIDCD], R01 DC005805 to T.L.S.). Public clinical trial registration (http://clinicaltrials.gov/show/NCT01332136) Determinants of Medical and Surgical Treatment Outcomes in Chronic Sinusitis. Z.M.S. is also supported by a grant from the NIH (NIDCD, R03 DC-013651 to Z.M.S.). T.L.S. is a consultant for IntersectENT (Menlo Park, CA), which is not affiliated with this investigation. Z.M.S. is a consultant for BrainLab (Westchester, IL), which is not affiliated with this investigation. Presented orally to the ARS at the annual Combined Otolaryngology Spring Meetings (COSM), April 22-26, 2015, Boston, MA (Abstract #1011). Public clinical trial registration: http://clinicaltrials.gov/show/NCT01332136. Determinants of Medical and Surgical Treatment Outcomes in Chronic Sinusitis. Received: 27 March 2015; Revised: 8 May 2015; Accepted: 3 June 2015 DOI: 10.1002/alr.21588 View this article online at wileyonlinelibrary.com.

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