Presentation (CTI)

OBJECTIVES: To assess, from the perspective of the Italian National Health Service (NHS), the economic positioning of a surgery-based approach including absorbable steroid-eluting sinus implants compared with dupilumab in patients with severe chronic rhinosinusitis with nasal polyps (CRSwNP) eligible for biologic therapy.
METHODS: A payer-oriented scenario analysis compared: (1) dupilumab 300 mg administered every 2 weeks and (2) endoscopic sinus surgery (ESS) including absorbable steroid-eluting sinus implants. The target population reflected patients meeting eligibility criteria for biologic therapy (SNOT-22 at least 50 and or NPS at least 5) with prior treatment failure. Italian direct treatment costs were considered: dupilumab €640 per dose over 6 months (approximately €8,320) and DRG-based surgical reimbursement (€2,798). The analysis was limited to direct treatment costs and excluded downstream healthcare resource use, providing a conservative estimate.
RESULTS: In patients eligible for biologic therapy, a surgery-based strategy may represent a lower-cost option within the same clinical decision space. Compared with surgery, dupilumab is associated with an additional direct cost of €5,522 per patient over 6 months. Clinical evidence indicates that ESS provides substantial early reduction in polyp burden, while the addition of steroid-eluting implants improves postoperative disease control, with significant reductions in polyp grade, sustained improvements in SNOT‑22, and reduced need for revision surgery at 6 months. These findings suggest that, in selected biologic-eligible patients, a surgery-based approach incorporating implants may achieve meaningful clinical control while potentially reducing reliance on high-cost biologic treatment.
CONCLUSIONS: From NHS payer perspective, a surgery-based approach incorporating steroid-eluting implants may represent an effective strategy to optimize disease control in selected severe CRSwNP patients, potentially delaying or reducing biologic therapy need. By improving postoperative outcomes and supporting sustained sinus patency, this approach may contribute to more efficient allocation of healthcare resources within the care pathway. Further real-world economic studies are warranted to quantify value, including cost implications.