Septoplasty is more costly but more effective than medical management for deviated septum

1. Immediate septoplasty is more costly but more clinically effective than medical management for deviated septum.

2. Over a 24-month horizon, immediate septoplasty becomes highly likely to be cost-effective, whereas its value at 12 months remains uncertain and sensitive to surgical costing methods.

Evidence Rating Level: 1 (Excellent)

Deviated nasal septum is commonly managed with either medical therapy (nasal sprays) or septoplasty, but robust cost-effectiveness evidence comparing these strategies has been lacking. The NAIROS trial, a multicentre, open-label RCT across 17 UK otolaryngology clinics, randomised 307 adults with moderate-to-severe nasal obstruction to immediate septoplasty or 6 months of medical management (steroid/saline nasal sprays) with the option for deferred septoplasty. Costs (NHS/personal social service perspective) and QALYs (derived from SF-36/SF-6D) were assessed at 12 months (within-trial analysis) and extrapolated to 24 months using a decision-tree model. Seemingly unrelated regression and multiple imputation were used to estimate incremental costs and effects, with bootstrapping and probabilistic sensitivity analysis to quantify uncertainty. At 12 months, immediate septoplasty was more costly (+£1193) and more effective (+0.044 QALYs) than medical management, yielding an ICER of £27,114/QALY (15% probability cost-effective at £20,000/QALY threshold; 79% using micro-costed surgery costs). At 24 months, septoplasty remained more costly (+£833) but more effective (+0.06 QALYs), with the ICER falling to £13,221/QALY and a 99% probability of cost-effectiveness.

Click here to read this study in BMJ Open

Image: PD

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