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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, MD1, Toby O. Steele, MD1, Jess C. Mace, MPH1, Zachary M. Soler, MD2, Luke Rudmik, MD,
MSc3 and Timothy L. Smith, MD, MPH1
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.
1Division of Rhinology and Sinus/Skull Base Surgery, Oregon Sinus
Center, Department of Otolaryngology–Head and Neck Surgery,
Oregon Health and Science University, Portland, OR; 2Division of
Rhinology and Sinus Surgery, Department of Otolaryngology–Head
and Neck Surgery, Medical University of South Carolina, Charleston,
SC; 3Division 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:
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
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%
Communication Disorders [NIDCD], R01 DC005805 to T.L.S.). Public clinical
trial registration 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:
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
International Forum of Allergy & Rhinology, Vol. 00, No. 00, xxxx 2015
Reprinted by permission of Int Forum Allergy Rhinol. 2015; 5(11):1018-1027.
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