The association of nasal airway obstruction with health is significant, and the health care resources utilized in open septorhinoplasty need to be included in health economic analyses.
Objectives
To describe the association of nasal airway obstruction and subsequent open septorhinoplasty with patient health.
Design, Setting, and Participants
A prospective case series study was conducted from September 30, 2009, to October 29, 2015, at 2 tertiary rhinologic centers in Sydney, Australia, among 144 consecutive adult patients (age, ≥18 years) with nasal airway obstruction from septal and nasal valve disorders.
Interventions
Open septorhinoplasty.
Main Outcomes and Measures
Patients were assessed before undergoing open septorhinoplasty and then 6 months after the procedure. Health utility values (HUVs) were derived from the 36-Item Short Form Health Survey. Nasal obstruction severity was also measured using the Nasal Obstruction Symptom Evaluation (NOSE) questionnaire and the Sino-Nasal Outcome Test 22 questionnaires.
Results
A total of 144 patients (85 women and 59 men; mean [SD] age, 38 [13] years) were assessed. The baseline mean (SD) HUV for patients in this study was 0.72 (0.09), which was below the weighted mean (SD) Australian norm of 0.81 (0.22). After open septorhinoplasty, the mean (SD) HUV improved to 0.78 (0.12) (P < .001). Improvements in HUV were associated with changes in disease-specific patient-reported outcome measures, including Nasal Obstruction Symptom Evaluation scores (r = –0.48; P = .01) and Sino-Nasal Outcome Test 22 scores (r = −0.68; P = .01).
Conclusions and Relevance
Patients with nasal airway obstruction reported baseline HUVs that were lower than the Australian norm and similar to those in individuals with chronic diseases with significant health expenditure. There was a clinically and statistically significant improvement in HUVs after open septorhinoplasty that was associated with a reduction in Nasal Obstruction Symptom Evaluation and Sino-Nasal Outcome Test 22 scores. Outcomes from this study may be used for health economic analyses of the benefit associated with open septorhinoplasty.
JessenM, MalmL. Definition, prevalence and development of nasal obstruction. Allergy. 1997; 52(40)(suppl):3-6. doi:10.1111/j.1398-9995.1997.tb04876.x, 9353553
2.
YanivE, HadarT, ShveroJ, RavehE. Objective and subjective nasal airflow. Am J Otolaryngol. 1997; 18(1):29-32. doi:10.1016/S0196-0709(97)90045-4, 9006674
3.
RheeJS, BookDT, BurzynskiM, SmithTL. Quality of life assessment in nasal airway obstruction. Laryngoscope. 2003; 113(7):1118-1122. doi:10.1097/00005537-200307000-00004, 12838007
4.
PawarSS, GarciaGJ, KimbellJS, RheeJS. Objective measures in aesthetic and functional nasal surgery: perspectives on nasal form and function. Facial Plast Surg. 2010; 26(4):320-327. doi:10.1055/s-0030-1262314, 20665410
5.
MohanS, FullerJC, FordSF, LindsayRW. Diagnostic and therapeutic management of nasal airway obstruction: advances in diagnosis and treatment. JAMA Facial Plast Surg. 2018; 20(5):409-418. doi:10.1001/jamafacial.2018.0279, 29801120
6.
RheeJS, SullivanCD, FrankDO, KimbellJS, GarciaGJ. A systematic review of patient-reported nasal obstruction scores: defining normative and symptomatic ranges in surgical patients. JAMA Facial Plast Surg. 2014; 16(3):219-225. doi:10.1001/jamafacial.2013.2473, 24604253
7.
TorranceGW. Measurement of health state utilities for economic appraisal. J Health Econ. 1986; 5(1):1-30. doi:10.1016/0167-6296(86)90020-2, 10311607
8.
RudmikL, DrummondM. Health economic evaluation: important principles and methodology. Laryngoscope. 2013; 123(6):1341-1347. doi:10.1002/lary.23943, 23483522
9.
WareJEJr, KosinskiM, GandekB, . The factor structure of the SF-36 Health Survey in 10 countries: results from the IQOLA Project: international quality of life assessment. J Clin Epidemiol. 1998; 51(11):1159-1165. doi:10.1016/S0895-4356(98)00107-3, 9817133
10.
StewartMG, WitsellDL, SmithTL, WeaverEM, YuehB, HannleyMT. Development and validation of the Nasal Obstruction Symptom Evaluation (NOSE) scale. Otolaryngol Head Neck Surg. 2004; 130(2):157-163. doi:10.1016/j.otohns.2003.09.016, 14990910
11.
HopkinsC, GillettS, SlackR, LundVJ, BrowneJP. Psychometric validity of the 22-item Sinonasal Outcome Test. Clin Otolaryngol. 2009; 34(5):447-454. doi:10.1111/j.1749-4486.2009.01995.x, 19793277
12.
BrowneJP, HopkinsC, SlackR, CanoSJ. The Sino-Nasal Outcome Test (SNOT): can we make it more clinically meaningful?. Otolaryngol Head Neck Surg. 2007; 136(5):736-741. doi:10.1016/j.otohns.2007.01.024, 17478207
13.
HawthorneG, OsborneRH, TaylorA, SansoniJ. The SF36 Version 2: critical analyses of population weights, scoring algorithms and population norms. Qual Life Res. 2007; 16(4):661-673. doi:10.1007/s11136-006-9154-4, 17268926
14.
BrazierJ, RobertsJ, DeverillM. The estimation of a preference-based measure of health from the SF-36. J Health Econ. 2002; 21(2):271-292. doi:10.1016/S0167-6296(01)00130-8, 11939242
15.
KharroubiSA, BrazierJE, RobertsJ, O’HaganA. Modelling SF-6D health state preference data using a nonparametric Bayesian method. J Health Econ. 2007; 26(3):597-612. doi:10.1016/j.jhealeco.2006.09.002, 17069909
16.
KharroubiSA, O’HaganA, BrazierJE. Estimating utilities from individual health preference data: a nonparametric Bayesian method. J R Stat Soc Ser C Appl Stat. 2005; 54(5):879-895. doi:10.1111/j.1467-9876.2005.00511.x
17.
BrazierJ, RobertsJ, TsuchiyaA, BusschbachJ. A comparison of the EQ-5D and SF-6D across seven patient groups. Health Econ. 2004; 13(9):873-884. doi:10.1002/hec.866, 15362179
18.
WaltersSJ, BrazierJE. What is the relationship between the minimally important difference and health state utility values? the case of the SF-6D. Health Qual Life Outcomes. 2003; 1(1):4. doi:10.1186/1477-7525-1-4, 12737635
19.
HawthorneG, KornS, RichardsonJ. Population norms for the AQoL derived from the 2007 Australian National Survey of Mental Health and Wellbeing. Aust N Z J Public Health. 2013; 37(1):7-16. doi:10.1111/1753-6405.12004, 23379800
20.
DolanRW. Minimally invasive nasal valve repair: an evaluation using the NOSE scale. Arch Otolaryngol Head Neck Surg. 2010; 136(3):292-295. doi:10.1001/archoto.2010.1, 20231650
21.
LindemannJ, TsakiropoulouE, KonstantinidisI, LindemannK. Normal aging does not deteriorate nose-related quality of life: assessment with “NOSE” and “SNOT-20” questionnaires. Auris Nasus Larynx. 2010; 37(3):303-307. doi:10.1016/j.anl.2009.09.012, 19906500
22.
AndréRF, VuykHD, AhmedA, GraamansK, Nolst TrenitéGJ. Correlation between subjective and objective evaluation of the nasal airway: a systematic review of the highest level of evidence. Clin Otolaryngol. 2009; 34(6):518-525. doi:10.1111/j.1749-4486.2009.02042.x, 20070760
23.
SolerZM, WittenbergE, SchlosserRJ, MaceJC, SmithTL. Health state utility values in patients undergoing endoscopic sinus surgery. Laryngoscope. 2011; 121(12):2672-2678. doi:10.1002/lary.21847, 22034223
LukLJ, SteeleTO, MaceJC, SolerZM, RudmikL, SmithTL. Health utility outcomes in patients undergoing medical management for chronic rhinosinusitis: a prospective multiinstitutional study. Int Forum Allergy Rhinol. 2015; 5(11):1018-1027. doi:10.1002/alr.21588, 26140502
26.
MoayeriF, HsuehY-S, ClarkeP, HuaX, DuntD. Health state utility value in chronic obstructive pulmonary disease (COPD); the challenge of heterogeneity: a systematic review and meta-analysis. COPD. 2016; 13(3):380-398. doi:10.3109/15412555.2015.1092953, 26678545
27.
GlasziouP, AlexanderJ, BellerE, ClarkeP; ADVANCE Collaborative Group. Which health-related quality of life score? a comparison of alternative utility measures in patients with type 2 diabetes in the ADVANCE trial. Health Qual Life Outcomes. 2007; 5(1):21. doi:10.1186/1477-7525-5-21, 17462100
28.
WyldM, MortonRL, HayenA, HowardK, WebsterAC. A systematic review and meta-analysis of utility-based quality of life in chronic kidney disease treatments. PLoS Med. 2012; 9(9):e1001307. doi:10.1371/journal.pmed.1001307, 22984353
29.
de GraaffB, NeilA, SandersonK, YeeKC, PalmerAJ. Quality of life utility values for hereditary haemochromatosis in Australia. Health Qual Life Outcomes. 2016; 14(1):31. doi:10.1186/s12955-016-0431-9, 26922941
30.
AhmadH, TaylorBV, van der MeiI, . The impact of multiple sclerosis severity on health state utility values: evidence from Australia. Mult Scler. 2017; 23(8):1157-1166. doi:10.1177/1352458516672014, 27698247
31.
SchmidlinM, FritschK, MatthewsF, ThurnheerR, SennO, BlochKE. Utility indices in patients with the obstructive sleep apnea syndrome. Respiration. 2010; 79(3):200-208. doi:10.1159/000222094, 19478475
32.
SlobogeanGP, YoungerA, ApostleKL, . Preference-based quality of life of end-stage ankle arthritis treated with arthroplasty or arthrodesis. Foot Ankle Int. 2010; 31(7):563-566. doi:10.3113/FAI.2010.0563, 20663421
33.
Osnes-RingenH, KvammeMK, KristiansenIS, . Cost-effectiveness analyses of elective orthopaedic surgical procedures in patients with inflammatory arthropathies. Scand J Rheumatol. 2011; 40(2):108-115. doi:10.3109/03009742.2010.503661, 21241197
34.
NormanR, ChurchJ, van den BergB, GoodallS. Australian health-related quality of life population norms derived from the SF-6D. Aust N Z J Public Health. 2013; 37(1):17-23. doi:10.1111/1753-6405.12005, 23379801
35.
MazariFAK, ShahinY, KhanJA, . Comparison of use of Short Form-36 domain scores and patient responses for derivation of preference-based SF6D index to calculate quality-adjusted life years in patients with intermittent claudication. Ann Vasc Surg. 2016; 34:164-170. doi:10.1016/j.avsg.2015.12.028, 27177712
36.
StrandV, CrawfordB, SinghJ, ChoyE, SmolenJS, KhannaD. Use of “spydergrams” to present and interpret SF-36 health-related quality of life data across rheumatic diseases. Ann Rheum Dis. 2009; 68(12):1800-1804. doi:10.1136/ard.2009.115550, 19910301
37.
McHorneyCA, WareJEJr, RaczekAE. The MOS 36-Item Short-Form Health Survey (SF-36): II, psychometric and clinical tests of validity in measuring physical and mental health constructs. Med Care. 1993; 31(3):247-263. doi:10.1097/00005650-199303000-00006, 8450681
38.
BharmalM, ThomasJIII. Comparing the EQ-5D and the SF-6D descriptive systems to assess their ceiling effects in the US general population. Value Health. 2006; 9(4):262-271. doi:10.1111/j.1524-4733.2006.00108.x, 16903996
39.
ButterworthP, CrosierT. The validity of the SF-36 in an Australian national household survey: demonstrating the applicability of the Household Income and Labour Dynamics in Australia (HILDA) Survey to examination of health inequalities. BMC Public Health. 2004; 4(1):44. doi:10.1186/1471-2458-4-44, 15469617
40.
RowenD, BrazierJ, RobertsJ. Mapping SF-36 onto the EQ-5D Index: how reliable is the relationship?. Health Qual Life Outcomes. 2009; 7(1):27. doi:10.1186/1477-7525-7-27, 19335878
41.
McDonoughCM, GroveMR, TostesonTD, LurieJD, HilibrandAS, TostesonAN. Comparison of EQ-5D, HUI, and SF-36–derived societal health state values among Spine Patient Outcomes Research Trial (SPORT) participants. Qual Life Res. 2005; 14(5):1321-1332. doi:10.1007/s11136-004-5743-2, 16047507
42.
McCaffreyN, KaambwaB, CurrowDC, RatcliffeJ. Health-related quality of life measured using the EQ-5D-5L: South Australian population norms. Health Qual Life Outcomes. 2016; 14(1):133. doi:10.1186/s12955-016-0537-0, 27644755
43.
FullerJC, LevesquePA, LindsayRW. Assessment of the EuroQol 5-dimension questionnaire for detection of clinically significant global health-related quality-of-life improvement following functional septorhinoplasty. JAMA Facial Plast Surg. 2017; 19(2):95-100. doi:10.1001/jamafacial.2016.1410, 27893020
44.
RemenschneiderAK, ScangasG, MeierJC, . EQ-5D–derived health utility values in patients undergoing surgery for chronic rhinosinusitis. Laryngoscope. 2015; 125(5):1056-1061. doi:10.1002/lary.25054, 25431320
