Cost-Effectiveness of Bioabsorbable Nasal Implant (Latera®) Versus Conservative Management for the Treatment of Nasal Airway Obstruction (NAO)

OBJECTIVES: NAO manifests as insufficient airflow and difficult breathing through the nose, with one of the causes weakness of the lateral wall resulting in lateral wall insufficiency (LWI). A bioabsorbable nasal implant (Latera) provides structural support for the upper and lower cartilage inside the lateral wall of the nose, improving the ease of breath and alleviating the symptoms of NAO. The procedure is minimally invasive – can be performed under local anesthesia in-office. The aim of this study was to assess the cost-effectiveness of Latera versus extended conservative management (ECM) in patients with NAO due to LWI. ECM consists of medical management (nasal steroids, antihistamines) and temporary external supports (eg, Breathe Right strips).

METHODS: A cost-utility analysis in the form of a 5-year Markov model was developed to assess the incremental cost-effectiveness of Latera versus ECM in patients with NAO due to LWI, confirmed by positive modified Cottle manoeuvre and having a self-reported Nasal Obstruction Symptom Evaluation (NOSE) score of greater than 55. Australian specific costs were estimated for the implant procedure, theatre time with SF-36 utility values as reported in the literature. Comparative clinical evidence was derived from the randomized controlled trial (RCT) comparing Latera versus sham (proxy for ECM) (Stolovitzky 2019).

RESULTS: Compared with ECM, incremental cost per quality adjusted life year (QALY) gained for Latera was $8,952. Over the 5 year model horizon, Latera provided 0.270 additional QALYs gained compared with ECM in patients with NAO due to LWI.

CONCLUSIONS: The results from this study found that the insertion of bioabsorbable implant using Latera was cost-effective in the treatment of NAO due to LWI. Its minimally invasive nature will allow patients who are currently contraindicated to or opt out of rhinoplasty surgery to receive an effective and safe NAO treatment directed at fixing the underlying pathology.