{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T19:16:28Z","timestamp":1783365388046,"version":"3.54.6"},"reference-count":22,"publisher":"BMJ","issue":"7","license":[{"start":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T00:00:00Z","timestamp":1783296000000},"content-version":"unspecified","delay-in-days":5,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000664","name":"Health Technology Assessment Programme","doi-asserted-by":"publisher","award":["14\/226\/07"],"award-info":[{"award-number":["14\/226\/07"]}],"id":[{"id":"10.13039\/501100000664","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,4,28]]},"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To estimate the cost-effectiveness of immediate septoplasty compared with 6\u2009months of medical management with the option for delayed septoplasty in individuals with nasal obstruction associated with septal deviation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Economic evaluation alongside a multicentre, open label, randomised controlled trial.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>17 otolaryngology clinics in the UK, recruiting from January 2018 to December 2019.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Adults aged\u226518 years with symptoms of nasal obstruction associated with septal deviation with at least moderate symptoms of nasal obstruction (score&gt;30 on the Nasal Obstruction and Symptom Evaluation scale).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interventions<\/jats:title>\n                    <jats:p>Participants were randomised to receive either septoplasty within 12 weeks of recruitment or 6 months of medical management (nasal steroid and saline spray) with the option for delayed septoplasty.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary and secondary outcome measures<\/jats:title>\n                    <jats:p>Incremental cost per quality-adjusted life year (QALY) gained at 12\u2009months. A UK National Health Service perspective was adopted, and surgery costs were estimated using a tariff and micro-costing. QALYs were estimated based on responses to the Short Form-36 (SF-36). Seemingly unrelated regression was used to estimate incremental costs and QALYs. A model-based analysis was used to extrapolate costs and effects to 24\u2009months. Sensitivity analyses were used to illustrate uncertainty.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In the within-trial analysis, immediate septoplasty was on average more costly (mean difference (95%\u2009CI) \u00a31193 (\u00a31018 to \u00a31368)) and more effective (mean difference (95%\u2009CI) 0.044 QALYs (0.03 to 0.06)) when compared with 6\u2009months of medical management with the option for deferred septoplasty. Immediate septoplasty had an incremental cost per QALY gained of \u00a327 114 in the base case analysis, which decreased to \u00a316 682 when micro-costing was used to estimate surgery costs. Immediate septoplasty had a 15% and 78%\u2009probability of being considered cost-effective at a \u00a320 000 threshold for an additional QALY, respectively. In the model-based analysis, immediate septoplasty remained more costly and more effective than 6\u2009months of medical management with the option for deferred septoplasty but had a 99% probability of being considered cost-effective at a \u00a320 000 threshold for an additional QALY.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Over a 24-month time horizon, immediate septoplasty would be cost-effective in the management of deviated nasal septum.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" specific-use=\"clinicaltrial results\" xlink:href=\"NCT16168569\">NCT16168569<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-107402","type":"journal-article","created":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T18:37:06Z","timestamp":1783363026000},"page":"e107402","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Cost-effectiveness of immediate septoplasty versus medical management with the option for delayed septoplasty for nasal airways obstruction: a multicentre, open-label, randomised controlled trial"],"prefix":"10.1136","volume":"16","clinical-trial-number":[{"clinical-trial-number":"nct16168569","registry":"10.18810\/clinical-trials-gov","type":"results"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6664-0671","authenticated-orcid":false,"given":"Tara","family":"Homer","sequence":"first","affiliation":[{"name":"Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sean","family":"Carrie","sequence":"additional","affiliation":[{"name":"Department of Ear, Nose and Throat, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle upon Tyne, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tony","family":"Fouweather","sequence":"additional","affiliation":[{"name":"Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dawn","family":"Teare","sequence":"additional","affiliation":[{"name":"Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nichola","family":"Waugh","sequence":"additional","affiliation":[{"name":"Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"O\u2019Hara","sequence":"additional","affiliation":[{"name":"Department of Ear, Nose and Throat, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle upon Tyne, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janet A","family":"Wilson","sequence":"additional","affiliation":[{"name":"Department of Ear, Nose and Throat, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle upon Tyne, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Ternent","sequence":"additional","affiliation":[{"name":"Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,7,6]]},"reference":[{"key":"2026070606101269000_16.7.e107402.1","doi-asserted-by":"crossref","unstructured":"Green R , Carrie S . 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