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Research Article
1 October 2025

Cost-effectiveness analysis of endoscopic sinus surgery versus external approach for sinonasal inverted papilloma

Authors: Juan David Gutiérrez-Posso https://orcid.org/0000-0001-5081-4473 [email protected], Aitor Zabala-López-de-Maturana https://orcid.org/0000-0002-7248-541X, Ana Maria Arango-Molina https://orcid.org/0009-0003-9514-6116, Francisco Santaolalla-Montoya https://orcid.org/0000-0003-1813-4069, and Francisco Javier Santaolalla-Sanchez https://orcid.org/0000-0002-2911-4728Author Info & Affiliations
Volume 14, Number 11
https://doi.org/10.57264/cer-2025-0109
PDFFormats

Abstract

Aim: Sinonasal inverted papilloma is a benign yet locally aggressive tumor with potential for recurrence. Surgical resection is the primary treatment, and both endoscopic sinus surgery (ESS) and external approaches are employed depending on tumor location and stage. While clinical outcomes of both techniques have been studied, their economic implications remain underexplored. Materials & methods: A retrospective cost-effectiveness analysis was conducted on 50 patients treated for histologically confirmed inverted papilloma between 1995 and 2018. Patients underwent either ESS or an external approach. Direct medical costs were calculated from hospital records, and effectiveness was measured by 5-year disease-free survival (DFS). Cost-minimization and cost-effectiveness analyses were performed, including subgroup evaluation by Krouse stage. Results: The median total cost was significantly lower for the endoscopic group (€7567.23) compared with the external group (€11,456.40; p = 0.018). Endoscopic surgery resulted in an average savings of approximately €4000 per patient over a 5-year period. In localized disease tumors (Krouse I–II), ESS was both less costly and equally effective. Although the external approach showed a slightly higher DFS (77.2 vs 67.8%), the incremental cost-effectiveness ratio (ICER) was €40,837.13, suggesting limited cost-justification for this benefit. Conclusion: Endoscopic surgery resulted in an average saving of approximately €4000 per patient over a 5-year period. While external approaches showed slightly better disease-free survival, the endoscopic technique proved significantly more cost-effective, offering a better balance between clinical outcomes and resource use.

Plain language summary

What is this article about?

This study compares two surgical techniques used to treat a rare nasal tumor called inverted papilloma. The two techniques are: endoscopic sinus surgery, which is minimally invasive and performed through the nose, and external surgery, which requires an incision on the face. We wanted to find out which method is more cost-effective, meaning which offers better value by balancing results and expenses.

What were the results?

We studied 50 patients treated at a single hospital. We found that the endoscopic technique was significantly less expensive, saving about €4000 per patient over 5 years, compared with the external approach. While the external surgery had a slightly higher tumor control rate (77 vs 68%), it also involved longer hospital stays and higher overall costs.

What do the results mean?

The endoscopic approach is more cost-effective in most cases, especially in patients with localized-stage tumors. These results support using the endoscopic method as the first choice when technically possible. Understanding the economic impact of each technique can help hospitals and surgeons make better decisions that balance clinical outcomes with responsible healthcare spending.

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Papers of special note have been highlighted as: • of interest; •• of considerable interest
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