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Dupilumab is a promising treatment for these patients, but its cost\u2010effectiveness has not yet been compared with aspirin (acetylsalicyclic acid, or ASA) desensitization, a known and effective treatment. We aimed to compare the cost\u2010effectiveness of ASA desensitization with dupilumab therapy for the treatment of CRSwNP in AERD.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Analyses of cost\u2010effectiveness, as measured in quality\u2010adjusted life years (QALYs), and cost\u2010utility, as measured in number of required revision endoscopic sinus surgeries (ESSs), were conducted.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>ASA desensitization after ESS was cost\u2010effective and dominated appropriate medical management. Adding salvage dupilumab was also cost\u2010effective (incremental cost\u2010effectiveness ratio [ICER] $135,517.33), and upfront dupilumab therapy was not cost\u2010effective in any scenario (ICER $273,181.32). The cost\u2010utility analysis demonstrated that, over a 10\u2010year period per patient, appropriate medical management after ESS cost $54,125.31 and resulted in 2.25 revision ESSs, ASA desensitization after ESS cost $53,775.15 and resulted in 2.02 revision ESSs, ASA desensitization with salvage dupilumab cost $121,176.25 and resulted in 1.68 revision ESSs, and upfront dupilumab cost $185,950.34 and resulted in 1.51 revision ESSs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Dupilumab for the treatment of severe CRSwNP was found to be cost\u2010effective as salvage therapy under the willingness\u2010to\u2010pay threshold of $150,000. Further analysis highlighted that the cost\u2010effectiveness of dupilumab was most sensitive to drug price and expected gains in quality of life. This suggests that additional investigation into improving patient population selection and tailoring treatment algorithms may improve the cost\u2010effectiveness of dupilumab in specific scenarios.<\/jats:p><\/jats:sec>","DOI":"10.1002\/alr.22865","type":"journal-article","created":{"date-parts":[[2021,7,26]],"date-time":"2021-07-26T12:07:36Z","timestamp":1627301256000},"page":"1626-1636","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":48,"title":["Cost\u2010effectiveness analysis comparing dupilumab and aspirin desensitization therapy for chronic rhinosinusitis with nasal polyposis in aspirin\u2010exacerbated respiratory disease"],"prefix":"10.1002","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7774-5786","authenticated-orcid":false,"given":"Michael","family":"Yong","sequence":"first","affiliation":[{"name":"Faculty of Medicine Division of Otolaryngology\u2013Head and Neck Surgery University of British Columbia  Vancouver BC Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu Qi","family":"Wu","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Division of Otolaryngology\u2013Head and Neck Surgery University of British Columbia  Vancouver BC Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joel","family":"Howlett","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Division of Otolaryngology\u2013Head and Neck Surgery University of British Columbia  Vancouver BC Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeromie","family":"Ballreich","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Management Johns Hopkins Bloomberg School of Public Health  Baltimore MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evan","family":"Walgama","sequence":"additional","affiliation":[{"name":"Division of Head &amp; 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