{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T17:17:20Z","timestamp":1783012640655,"version":"3.54.6"},"reference-count":25,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T00:00:00Z","timestamp":1771545600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T00:00:00Z","timestamp":1771545600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int Forum Allergy Rhinol"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Chronic rhinosinusitis with nasal polyps (CRSwNP) is managed after sinus surgery with topical corticosteroids. Given limited distribution of nasal steroid sprays, patients have the option of either steroid nasal irrigation (SNI) or exhalation delivery system with fluticasone (EDS\u2010FLU). This study evaluates the cost\u2010effectiveness of EDS\u2010FLU compared to SNI for CRSwNP.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A cohort\u2010style Markov decision\u2010tree economic model with a 33\u2010year time horizon was developed in TreeAgePro. Because EDS\u2010FLU is not currently covered by Medicare, costs of medications were estimated using retail pricing. A willingness\u2010to\u2010pay threshold of $50,000\/quality adjusted life year (QALY) was used to determine cost\u2010effectiveness. One\u2010way and probabilistic sensitivity analysis was conducted using 10,000 Monte Carlo simulations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>EDS\u2010FLU had an incremental benefit of 0.41 QALYs compared to SNI. In base case analysis, EDS\u2010FLU costs $140,966.63 after the study period, whereas SNI costs $40,817.50. With an ICER of $244,185.37\/QALY, SNI is the more cost\u2010effective strategy. Probabilistic sensitivity analysis reported SNI as the cost\u2010effective strategy in 98.50% of simulations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Compared to EDS\u2010FLU, SNI is the cost\u2010effective strategy for treating CRSwNP following FESS. Changes in drug pricing and improvements in patient selection may cause adjustments in the most cost\u2010effective strategy for CRSwNP management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/alr.70121","type":"journal-article","created":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T11:42:31Z","timestamp":1771587751000},"page":"689-694","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Cost Utility Analysis of Fluticasone Exhalation Delivery System Versus Budesonide Nasal Irrigation for Chronic Rhinosinusitis With Nasal Polyps"],"prefix":"10.1002","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-9159-7255","authenticated-orcid":false,"given":"Daniel","family":"Xiao","sequence":"first","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head and Neck Surgery McGovern Medical School of The University of Texas Health Science Center at Houston  Houston Texas USA"},{"name":"Center for Immunology and Autoimmune Diseases The Brown Foundation Institute of Molecular Medicine for the Prevention of Human Diseases McGovern Medical School of The University of Texas Health Science Center at Houston  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin J.","family":"Citardi","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head and Neck Surgery McGovern Medical School of The University of Texas Health Science Center at Houston  Houston Texas USA"},{"name":"Center for Immunology and Autoimmune Diseases The Brown Foundation Institute of Molecular Medicine for the Prevention of Human Diseases McGovern Medical School of The University of Texas Health Science Center at Houston  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9845-2165","authenticated-orcid":false,"given":"William C.","family":"Yao","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head and Neck Surgery McGovern Medical School of The University of Texas Health Science Center at Houston  Houston Texas USA"},{"name":"Center for Immunology and Autoimmune Diseases The Brown Foundation Institute of Molecular Medicine for the Prevention of Human Diseases McGovern Medical School of The University of Texas Health Science Center at Houston  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6078-8010","authenticated-orcid":false,"given":"Amber U.","family":"Luong","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head and Neck Surgery McGovern Medical School of The University of Texas Health Science Center at Houston  Houston Texas USA"},{"name":"Center for Immunology and Autoimmune Diseases The Brown Foundation Institute of Molecular Medicine for the Prevention of Human Diseases McGovern Medical School of The University of Texas Health Science Center at Houston  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,2,20]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.4193\/Rhin20.601"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.2500\/ajra.2014.28.4026"},{"issue":"3","key":"e_1_2_9_4_1","first-page":"180","article-title":"Site of Origin of Nasal Polyps: Relevance to Pathogenesis and Management","volume":"43","author":"Andrews A. 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