The value of endoscopic sinus surgery in chronic rhinosinusitis.

OBJECTIVES: Chronic rhinosinusitis (CRS) is a disease with significant impacts at both a societal and personal level. There has been an increase in emphasis on patient-centered care and patient outcomes, with value becoming a commonplace concept in health care systems. This review seeks to better define the value that endoscopic sinus surgery (ESS) provides in the treatment of CRS. DATA SOURCES: PubMed literature review. REVIEW METHODS: A review of published literature related to ESS and its effects on CRS patients from multiple perspectives (quality outcomes, patient satisfaction, cost-effectiveness) was integrated and analyzed through the viewpoint of a value equation. RESULTS: ESS provides long-term quality outcomes in both patient-reported outcome measures (PROMs) as well as in objective metrics for patients refractory to medical therapy. The vast majority undergoing ESS are satisfied both in the short and long-term with their decision to pursue surgery. Treatment of CRS with ESS is generally more cost-effective than continued medical therapy (CMT), especially in refractory patients. Taken together, the combination of improved outcomes as well as patient satisfaction after ESS in relation to the costs of surgery provides significant quantifiable value to CRS patients. CONCLUSION: ESS clearly provides value in the treatment of CRS. Understanding both quality and outcome metrics along with patient expectations and priorities will assist providers in generating a more personalized and value-based approach to patients with CRS. LEVEL OF EVIDENCE: 5.