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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
0.824
Endoscopy score
0.093
0.574
−
0.021
0.797
−
0.096
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
−
0.241
0.352
−
0.039
0.706
−
0.212
0.447
Productivity
Missed days (out of past 90)
−
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
0.015
0.960
0.056
0.637
−
0.290
0.416
Productivity
Missed days (out of past 90)
−
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.
International Forum of Allergy & Rhinology, Vol. 00, No. 00, xxxx 2015
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