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Health utility values in medical management of CRS

TABLE 4. Bivariate correlation coefficients between baseline SF-6D health state utility values, clinical measures of disease severity, and missed days of productivity

Medical management (n = 40)

Surgical intervention (n = 152)

Treatment crossover (n = 20)

R s

p

R s

p

R s

p

Clinical measures of disease severity CT score

0.173

0.336

0.069

0.400

− 0.055 − 0.096

0.824

Endoscopy score

0.093

0.574

− 0.021

0.797

0.689

Productivity Missed days (out of past 90)

− 0.470

0.003

− 0.510

< 0.001

− 0.510

0.022

CT = computed tomography; R s = Spearman’s rank correlation coefficient; SF-6D = Medical Outcomes Study Short Form-6D. TABLE 5. Bivariate correlation coefficients between 6-month SF-6D health state utility values, clinical measures of disease severity, and missed days of productivity

Medical management (n = 40)

Surgical intervention (n = 152)

Treatment crossover (n = 20)

R s

p

R s

p

R s

p

Clinical measures of disease severity Endoscopy score Productivity Missed days (out of past 90)

− 0.241

0.352

− 0.039

0.706

− 0.212

0.447

− 0.336

0.039

− 0.421

< 0.001

− 0.504

0.028

R s = Spearman’s rank correlation coefficient; SF-6D = Medical Outcomes Study Short Form-6D. TABLE 6. Bivariate correlation coefficients between 12-month SF-6D health state utility values, clinical measures of disease severity, and missed days of productivity

Medical management (n = 40)

Surgical intervention (n = 152)

Treatment crossover (n = 20)

R s

p

R s

p

R s

p

Clinical measures of disease severity Endoscopy score Productivity Missed days (out of past 90)

0.015

0.960

0.056

0.637

− 0.290

0.416

− 0.412

0.010

− 0.546

< 0.001

0.115

0.651

R s = Spearman’s rank correlation coefficient; SF-6D = Medical Outcomes Study Short Form-6D.

the use of health utility values to determine economic im- pact of this disease process. The estimated productivity cost associated with refractory CRS is about $10,000 per patient. 24 In this study, patients who elected continued medical management reported stable mean utility values up to 12 months. Despite lack of improvement of mean util- ity from baseline in the medical management group, their overall mean health utility was comparable to the surgi- cal group at 6-month ( p = 0.257) and 12-month follow- up ( p = 0.269). These findings support prior studies that show a tendency for patients to self-select appropriate ther- apy based on their QOL. 25 Patients with a mild reduc- tion in QOL measures chose medical therapy, whereas those with moderate to severe QOL impairment chose

ESS. 6,9,26,27 Further research is needed to further clarify the specific QOL factors that drive patients to choose medical management. Recent studies have also attempted to clarify the role of medical management for refractory CRS. Smith and Rudmik 28 showed severe reductions in baseline QOL, sig- nificant worsening of endoscopy scores, and increased missed days of work in refractory CRS patients treated with medical therapy while waiting to undergo ESS. These patients report worse baseline QOL than the pa- tients in this study who elected medical management and achieved stable QOL. This variation in outcome high- lights the importance of accurate assessment of the impact of the chronic disease process in shared patient-provider decision-making.

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