Kristine A. Smith

Cost of adult chronic rhinosinusitis: A systematic review

The objective of this systematic review was to summarize the literature evaluating the costs associated with the management of adult chronic rhinosinusitis (CRS) using Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines.

Endoscopic sinus surgery compared to continued medical therapy for patients with refractory chronic rhinosinusitis

The decision to continue medical therapy or recommend endoscopic sinus surgery (ESS) can be challenging in patients with refractory chronic rhinosinusitis (CRS). The objective of this study was to evaluate continued medical therapy vs ESS for patients with refractory CRS who have severe reductions in baseline disease‐specific quality of life (QoL).

Impact of continued medical therapy in patients with refractory chronic rhinosinusitis

Patients with refractory chronic rhinosinusitis (RCRS) have persistent symptoms despite best medical therapy. Some evidence suggests continued medical therapy (CMT) is appropriate for patients with RCRS. The primary objective of this study was to evaluate the clinical impact of CMT in patients with RCRS who have significant reductions in baseline disease‐specific quality of life (QoL) and would be considered candidates for endoscopic sinus surgery (ESS).

Cost Collection and Analysis for Health Economic Evaluation

Objective To improve the understanding of common health care cost collection, estimation, analysis, and reporting methodologies. Data Sources Ovid MEDLINE (1947 to December 2012), Cochrane Central register of Controlled Trials, Database of Systematic Reviews, Health Technology Assessment, and National Health Service Economic Evaluation Database. Review Methods This article discusses the following cost collection methods: defining relevant resources, quantification of consumed resources, and resource valuation. It outlines the recommendations for cost reporting in economic evaluations and reviews the techniques on how to handle cost data uncertainty. Last, it discusses the controversial topics of future costs and patient productivity losses. Conclusion Health care cost collection and estimation can be challenging, and an organized approach is required to optimize accuracy of economic evaluation outcomes. Implications for Practice Understanding health care cost collection and estimation techniques will improve both critical appraisal and development of future economic evaluations.

Safety of long-term high-volume sinonasal budesonide irrigations for chronic rhinosinusitis.

Off‐label high‐volume sinonasal budesonide irrigations are commonly used during the management of chronic rhinosinusitis (CRS). Although short‐term use (4 to 8 weeks) has been demonstrated to be safe, the long‐term effects on the hypothalamic‐pituitary‐adrenal (HPA) axis remain unclear. The objective of this study is to determine whether CRS patients using long‐term (minimum greater than 12 months) budesonide sinonasal irrigations have evidence of HPA axis suppression.

Routine magnetic resonance imaging for idiopathic olfactory loss: a modeling-based economic evaluation.

IMPORTANCE Idiopathic olfactory loss is a common clinical scenario encountered by otolaryngologists. While trying to allocate limited health care resources appropriately, the decision to obtain a magnetic resonance imaging (MRI) scan to investigate for a rare intracranial abnormality can be difficult. OBJECTIVE To evaluate the cost-effectiveness of ordering routine MRI in patients with idiopathic olfactory loss. DESIGN, SETTING, AND PARTICIPANTS We performed a modeling-based economic evaluation with a time horizon of less than 1 year. Patients included in the analysis had idiopathic olfactory loss defined by no preceding viral illness or head trauma and negative findings of a physical examination and nasal endoscopy. INTERVENTIONS Routine MRI vs no-imaging strategies. MAIN OUTCOMES AND MEASURES We developed a decision tree economic model from the societal perspective. Effectiveness, probability, and cost data were obtained from the published literature. Litigation rates and costs related to a missed diagnosis were obtained from the Physicians Insurers Association of America. A univariate threshold analysis and multivariate probabilistic sensitivity analysis were performed to quantify the degree of certainty in the economic conclusion of the reference case. The comparative groups included those who underwent routine MRI of the brain with contrast alone and those who underwent no brain imaging. The primary outcome was the cost per correct diagnosis of idiopathic olfactory loss. RESULTS The mean (SD) cost for the MRI strategy totaled

Cost-effectiveness of positron emission tomography-CT in the evaluation of cancer of unknown primary of the head and neck

2400.00 (

Kawasaki disease is associated with sensorineural hearing loss: A systematic review

1717.54) and was effective 100% of the time, whereas the mean (SD) cost for the no-imaging strategy totaled

Medical therapy, refractory chronic rhinosinusitis, and productivity costs

86.61 (

Assessment of the current Canadian rhinology workforce.

107.40) and was effective 98% of the time. The incremental cost-effectiveness ratio for the MRI strategy compared with the no-imaging strategy was