Introduction
Methods
Structure of the Model
Sources of Data
Disease Outcomes and Clinical Parameters
Parameter | BDNS | MFNS | BANS |
---|---|---|---|
TNSS | 2 | 3 | 2 |
TOSS | 1 | 2 | 3 |
PGA | 1 | 2 | 3 |
ES | 4 | 7 | 8 |
Epistaxis | 2 | 1 | 2 |
Long-term side effect | 3 | 0 | 2 |
Systemic ocular side effects | 2 | 0 | 0 |
AES | 7 | 1 | 4 |
TIX (ES/AES) | 0.57 | 7 | 2 |
Resource Utilization and Costs
Sensitivity Analyses
Results
Base-Case Analysis
Variable | Baseline value | Low value | High value |
---|---|---|---|
Treatment with beclomethasone dipropionate nasal spray | |||
Improvement of symptoms | 44.0 | 40.0 | 48.0 |
Improvement of nasal symptoms | 50.0 | 45.0 | 50.0 |
Improvement of ocular symptoms | 25.0 | 23.0 | 28.0 |
Side effects | 77.0 | 69.0 | 85.0 |
Epistaxis | 28.0 | 25.0 | 31.0 |
Treatment with mometasone furoate nasal spray | |||
Improvement of symptoms | 77.0 | 69.0 | 85.0 |
Improvement of nasal symptoms | 43.0 | 39.0 | 47.0 |
Improvement of ocular symptoms | 28.0 | 25.0 | 31.0 |
Side effects | 11.0 | 10.0 | 12.0 |
Epistaxis | 100.0 | 0.0 | 0.0 |
Treatment with budesonide aquous nasal spray | |||
Improvement of symptoms | 88.0 | 79.2 | 96.8 |
Improvement of nasal symptoms | 25.0 | 23.0 | 28.0 |
Improvement of ocular symptoms | 37.0 | 33.0 | 41.0 |
Side effects | 44.0 | 40.0 | 48.0 |
Epistaxis | 44.0 | 40.0 | 48.0 |
Cost item | Baseline value | Low value | High value |
---|---|---|---|
Drug-related adverse events with topical intranasal corticosteroids | |||
Cauterization | 17.81 | 13.36 | 22.26 |
Anterior nasal packing | 28.56 | 21.42 | 35.70 |
Topical antibiotic | 3.21 | 2.41 | 4.01 |
Analgesic | 3.47 | 2.60 | 4.33 |
Seric cortisol | 26.75 | 20.06 | 33.44 |
Diagnostic and/or therapeutic proceduresa
| |||
Immunoglobulin E | 32.41 | 24.30 | 40.51 |
Skin prick testing | 80.26 | 60.20 | 100.33 |
Immunotherapyb
| 62.02 | 46.51 | 77.52 |
Lateral airway radiography | 18.43 | 13.82 | 23.04 |
CT scan of the paranasal sinuses | 193.61 | 145.21 | 242.01 |
Impedance audiometry | 6.02 | 4.51 | 7.52 |
Endoscopic nasopharyngoscopy | 474.73 | 356.05 | 593.41 |
Tympanostomy tube placement | 200.12 | 150.09 | 250.15 |
Turbinoplasty | 433.26 | 324.95 | 541.58 |
Adenoidectomy | 333.47 | 250.10 | 416.84 |
Septoplasty | 824.84 | 618.63 | 1,031.05 |
Medical consultationsc
| 24.08 | 18.06 | 30.10 |
Topical intranasal corticosteroids | |||
Beclomethasone dipropionate nasal sprayd
| 2.34 | 2.29 | 2.76 |
Mometasone furoate nasal spraye
| 13.29 | 9.13 | 14.25 |
Budesonide aquous nasal sprayf
| 43.62 | 37.59 | 46.22 |
Resources | Rate of resource utilization | Range |
---|---|---|
Patients with no improvement of allergic rhinitis symptoms | ||
Immunoglobulin Ea
| 3.7% | 1.7–5.7% |
Skin prick testinga
| 46.7% | 40.0–51.7% |
Immunotherapya
| 50.0% | 38.3–58.3% |
Lateral airway radiographya
| 34.4% | 31.0–37.3% |
CT scan of the paranasal sinusesa
| 41.7% | 37.3–46.0% |
Impedance audiometrya
| 3.3% | 1.7–6.7% |
Endoscopic nasopharyngoscopya
| 50.0% | 44.0–55.0% |
Tympanostomy tube placementa
| 0.7% | 0.0–2.0% |
Turbinoplastya
| 25.0% | 20.0–30.0% |
Adenoidectomya
| 7.7% | 3.3–13.3% |
Septoplastya
| 2.3% | 1.0–6.3% |
Pediatric consultationb
| 4.3 | 4.0–5.0 |
Otolaryngologist consultationb
| 4.3 | 4.0–5.0 |
Allergologist consultationb
| 3.0 | 2.0–4.0 |
Patients with treatment-related adverse events with INS | ||
Epistaxis | ||
Cauterizationa
| 4.7% | 2.3–9.7% |
Anterior nasal packinga
| 0.7% | 0.3–2.7% |
Topical antibiotica
| 3.7% | 2–7.3% |
Analgesica
| 1.3% | 0.3–3% |
Pediatric consultationb
| 3.6 | 3.0–4.0 |
Otolaryngologist consultationb
| 2.6 | 2.0–3.0 |
Treatment-related adverse event other than epistaxis | ||
Pediatric consultationb
| 3.0 | 2.0–4.0 |
Endocrinologic consultationb
| 2.0 | 1.0–3.0 |
Ophthalmologist consultationb
| 2.0 | 1.0–3.0 |
Seric cortisol measurementc
| 2.0 | 1.0–3.0 |
Category | Strategy | Cost (US$) | Incremental cost (US$) | Effectiveness (TIX score) | Incremental effectiveness (TIX score) | Cost/effectiveness |
---|---|---|---|---|---|---|
MFNS | 229.78 | – | 0.9724 | – | 236.31 | |
Absolutely dominated | BDNS | 289.74 | 59.96 | 0.8712 | −0.1012 | 332.58 |
Sensitivity Analyses
Probability distribution | Distribution parameters | Distribution parameters |
---|---|---|
Beta distribution | Alpha | Beta |
Probability of improvement of symptoms | ||
BDNS | 270.600 | 344.400 |
MFNS | 84.459 | 25.228 |
BANS | 47.120 | 6.425 |
Probability of improvement of nasal symptoms | ||
BDNS | 199.500 | 199.500 |
MFNS | 263.052 | 348.697 |
BANS | 299.750 | 899.250 |
Probability of improvement of ocular symptoms | ||
BDNS | 299.750 | 899.250 |
MFNS | 250.600 | 644.400 |
BANS | 215.247 | 366.502 |
Probability of side effects | ||
BDNS | 84.459 | 25.228 |
MFNS | 430.650 | 3484.350 |
BANS | 270.600 | 344.400 |
Probability of epistaxis | ||
BDNS | 250.600 | 644.400 |
MFNS | – | – |
BANS | 270.600 | 344.400 |
Gamma distribution | Alpha | Lambda |
Cost of cauterization | 64.072 | 3.597 |
Cost of anterior nasal packing | 64.000 | 2.241 |
Cost of topical antibiotic | 64.400 | 20.062 |
Cost of analgesic | 64.370 | 18.550 |
Cost of seric cortisol | 63.952 | 2.390 |
Cost of immunoglobulin E | 64.039 | 1.975 |
Cost of skin prick testing | 64.000 | 0.797 |
Cost of immunotherapy | 64.000 | 1.031 |
Cost of lateral airway radiography | 63.930 | 3.468 |
Cost of CT scan of the paranasal sinuses | 64.006 | 0.330 |
Cost of impedance audiometry | 64.000 | 10.631 |
Cost of endoscopic nasopharyngoscopy | 2583.447 | 5.441 |
Cost of tympanostomy tube placement | 64.000 | 0.319 |
Cost of turbinoplasty | 64.000 | 0.147 |
Cost of adenoidectomy | 63.996 | 0.191 |
Cost of septoplasty | 64.000 | 0.077 |
Cost of BDNS | 396.603 | 169.488 |
Cost of MFNS | 107.802 | 8.111 |
Cost of BANS | 408.761 | 9.370 |