{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T10:19:36Z","timestamp":1761905976789,"version":"build-2065373602"},"reference-count":28,"publisher":"Becaris Publishing Limited","issue":"11","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Comp. Eff. Res."],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:p>\n                    <jats:bold>Aim:<\/jats:bold>\n                    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.\n                    <jats:bold>Materials &amp; methods:<\/jats:bold>\n                    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.\n                    <jats:bold>Results:<\/jats:bold>\n                    The median total cost was significantly lower for the endoscopic group (\u20ac7567.23) compared with the external group (\u20ac11,456.40; p\u00a0=\u00a00.018). Endoscopic surgery resulted in an average savings of approximately \u20ac4000 per patient over a 5-year period. In localized disease tumors (Krouse I\u2013II), 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 \u20ac40,837.13, suggesting limited cost-justification for this benefit.\n                    <jats:bold>Conclusion:<\/jats:bold>\n                    Endoscopic surgery resulted in an average saving of approximately \u20ac4000 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.\n                  <\/jats:p>","DOI":"10.57264\/cer-2025-0109","type":"journal-article","created":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T10:28:42Z","timestamp":1759314522000},"source":"Crossref","is-referenced-by-count":0,"title":["Cost-effectiveness analysis of endoscopic sinus surgery versus external approach for sinonasal inverted papilloma"],"prefix":"10.57264","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5081-4473","authenticated-orcid":false,"given":"Juan David","family":"Guti\u00e9rrez-Posso","sequence":"first","affiliation":[{"name":"Otorhinolaryngology Department, Basurto University Hospital, OSI-Bilbao Basurto, Basque Country, Spain"},{"name":"BioBizkaia Health Research Institute, Barakaldo, Basque Country, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7248-541X","authenticated-orcid":false,"given":"Aitor","family":"Zabala-L\u00f3pez-de-Maturana","sequence":"additional","affiliation":[{"name":"Otorhinolaryngology Department, Basurto University Hospital, OSI-Bilbao Basurto, Basque Country, Spain"},{"name":"BioBizkaia Health Research Institute, Barakaldo, Basque Country, Spain"},{"name":"School of Medicine, University of the Basque Country, Bilbao, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-9514-6116","authenticated-orcid":false,"given":"Ana Maria","family":"Arango-Molina","sequence":"additional","affiliation":[{"name":"BioBizkaia Health Research Institute, Barakaldo, Basque Country, Spain"},{"name":"Radiology Department, Cruces University Hospital, Barakaldo, Basque Country, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1813-4069","authenticated-orcid":false,"given":"Francisco","family":"Santaolalla-Montoya","sequence":"additional","affiliation":[{"name":"Otorhinolaryngology Department, Basurto University Hospital, OSI-Bilbao Basurto, Basque Country, Spain"},{"name":"BioBizkaia Health Research Institute, Barakaldo, Basque Country, Spain"},{"name":"School of Medicine, University of the Basque Country, Bilbao, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2911-4728","authenticated-orcid":false,"given":"Francisco Javier","family":"Santaolalla-Sanchez","sequence":"additional","affiliation":[{"name":"Otorhinolaryngology Department, Basurto University Hospital, OSI-Bilbao Basurto, Basque Country, Spain"},{"name":"BioBizkaia Health Research Institute, Barakaldo, Basque Country, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"36897","reference":[{"issue":"2","key":"e_1_3_6_3_2","first-page":"291","article-title":"The role of the Schneiderian membrane in the pathogenesis of sinonasal papillomas","volume":"118","author":"Lawson W","year":"2008","unstructured":"Lawson W, Schlecht NF, Brandwein-Gensler M. The role of the Schneiderian membrane in the pathogenesis of sinonasal papillomas. Laryngoscope 118(2), 291\u2013296 (2008).","journal-title":"Laryngoscope"},{"key":"e_1_3_6_4_2","first-page":"18","volume-title":"WHO Classification of Tumors: Head and Neck","author":"Hunt JL","year":"2017","unstructured":"Hunt JL, el-Naggar A, Slootweg PJ, Chan JKC. Sinonasal papilloma, inverted type. In: WHO Classification of Tumors: Head and Neck. IARC Press, Paris, France, 18\u201319 (2017)."},{"issue":"5","key":"e_1_3_6_5_2","doi-asserted-by":"crossref","first-page":"582","DOI":"10.1002\/lary.5541040513","article-title":"The inverted Schneiderian papilloma: a 25-year study","volume":"104","author":"Vrabec DP","year":"1994","unstructured":"Vrabec DP. The inverted Schneiderian papilloma: a 25-year study. Laryngoscope 104(5 Pt 1), 582\u2013587 (1994).","journal-title":"Laryngoscope"},{"issue":"3","key":"e_1_3_6_6_2","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1007\/s12105-014-0527-7","article-title":"Carcinoma ex-Schneiderian papilloma (malignant transformation): a clinicopathologic and immunophenotypic study of 20 cases combined with a comprehensive review of the literature","volume":"8","author":"Nudell J","year":"2014","unstructured":"Nudell J, Chiosea S, Thompson LDR. Carcinoma ex-Schneiderian papilloma (malignant transformation): a clinicopathologic and immunophenotypic study of 20 cases combined with a comprehensive review of the literature. Head Neck Pathol. 8(3), 269\u2013286 (2014).","journal-title":"Head Neck Pathol."},{"issue":"3","key":"e_1_3_6_7_2","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1007\/s12105-017-0799-9","article-title":"OSPs and ESPs and ISPs, Oh My! An update on sinonasal (Schneiderian) papillomas","volume":"11","author":"Bishop JA","year":"2017","unstructured":"Bishop JA. OSPs and ESPs and ISPs, Oh My! An update on sinonasal (Schneiderian) papillomas. Head Neck Pathol. 11(3), 269\u2013277 (2017).","journal-title":"Head Neck Pathol."},{"issue":"8","key":"e_1_3_6_8_2","doi-asserted-by":"crossref","first-page":"758","DOI":"10.1017\/S0022215100141611","article-title":"Endoscopic resection of inverted papilloma of the nose and paranasal sinuses","volume":"112","author":"Sham CL","year":"1998","unstructured":"Sham CL, Woo JK, van Hasselt CA. Endoscopic resection of inverted papilloma of the nose and paranasal sinuses. J. Laryngol. Otol. 112(8), 758\u2013764 (1998).","journal-title":"J. Laryngol. Otol."},{"issue":"4","key":"e_1_3_6_9_2","first-page":"400","article-title":"Endoscopic medial maxillectomy: a minimally invasive approach for maxillary sinus pathology","volume":"124","author":"Kamel RH","year":"2010","unstructured":"Kamel RH. Endoscopic medial maxillectomy: a minimally invasive approach for maxillary sinus pathology. J. Laryngol. Otol. 124(4), 400\u2013404 (2010).","journal-title":"J. Laryngol. Otol."},{"issue":"3","key":"e_1_3_6_10_2","first-page":"208","article-title":"Endoscopic management of sinonasal malignancies: 10-year experience","volume":"25","author":"Castelnuovo P","year":"2011","unstructured":"Castelnuovo P, Dallan I, Locatelli D Endoscopic management of sinonasal malignancies: 10-year experience. Am. J. Rhinol. Allergy 25(3), 208\u2013216 (2011).","journal-title":"Am. J. Rhinol. Allergy"},{"issue":"3","key":"e_1_3_6_11_2","doi-asserted-by":"crossref","first-page":"476","DOI":"10.1016\/j.otohns.2005.11.038","article-title":"Endoscopic resection of sinonasal inverted papilloma: a meta-analysis","volume":"134","author":"Busquets JM","year":"2006","unstructured":"Busquets JM, Hwang PH. Endoscopic resection of sinonasal inverted papilloma: a meta-analysis. Otolaryngol. Head Neck Surg. 134(3), 476\u2013482 (2006).","journal-title":"Otolaryngol. Head Neck Surg."},{"issue":"3","key":"e_1_3_6_12_2","first-page":"102920","article-title":"Endoscopic medial maxillectomy: indications, technique, and outcomes","volume":"42","author":"Sun W","year":"2021","unstructured":"Sun W, Zhang Y, Li S, Xu X, Xu G. Endoscopic medial maxillectomy: indications, technique, and outcomes. Am. J. Otolaryngol. 42(3), 102920 (2021).","journal-title":"Am. J. Otolaryngol."},{"issue":"1","key":"e_1_3_6_13_2","first-page":"16","article-title":"Endoscopic resection of sinonasal inverted papilloma: systematic review and meta-analysis","volume":"164","author":"Bhattacharyya N","year":"2021","unstructured":"Bhattacharyya N. Endoscopic resection of sinonasal inverted papilloma: systematic review and meta-analysis. Otolaryngol. Head Neck Surg. 164(1), 16\u201324 (2021).","journal-title":"Otolaryngol. Head Neck Surg."},{"issue":"2","key":"e_1_3_6_14_2","first-page":"183","article-title":"Endoscopic sinus surgery in frontal sinus inverted papilloma: a systematic review","volume":"15","author":"Geiger G","year":"2025","unstructured":"Geiger G, Thomann I, Wellenstein D, Plettenberg A, Vogl TJ, Knoop H. Endoscopic sinus surgery in frontal sinus inverted papilloma: a systematic review. J. Pers. Med. 15(2), 183 (2025).","journal-title":"J. Pers. Med."},{"issue":"1","key":"e_1_3_6_15_2","first-page":"71","article-title":"Endoscopic versus external resection of sinonasal inverted papilloma: meta-analysis","volume":"38","author":"Kim DY","year":"2022","unstructured":"Kim DY, Lee SH, Cho JH, Chung YS. Endoscopic versus external resection of sinonasal inverted papilloma: meta-analysis. Egypt. J. Otolaryngol. 38(1), 71 (2022).","journal-title":"Egypt. J. Otolaryngol."},{"key":"e_1_3_6_16_2","first-page":"495","article-title":"Current advances in the basic research and clinical management of sinonasal inverted papilloma","volume":"17","author":"Sauter A","year":"2007","unstructured":"Sauter A, Matharu R, H\u00f6rmann K, Naim R. Current advances in the basic research and clinical management of sinonasal inverted papilloma. Oncol. Rep. 17, 495\u2013504 (2007).","journal-title":"Oncol. Rep."},{"key":"e_1_3_6_17_2","doi-asserted-by":"crossref","first-page":"1154","DOI":"10.1002\/hed.21589","article-title":"Limitations and complications of endoscopic surgery for treatment of sinonasal inverted papilloma: a reassessment after 212 cases","volume":"33","author":"Lombardi D","year":"2011","unstructured":"Lombardi D, Tomenzoli D, Butta L, Bizzoni A, Farina D, Nicolai P. Limitations and complications of endoscopic surgery for treatment of sinonasal inverted papilloma: a reassessment after 212 cases. Head Neck 33, 1154\u20131161 (2011).","journal-title":"Head Neck"},{"issue":"10","key":"e_1_3_6_18_2","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1016\/S0025-7753(04)74249-9","article-title":"Evaluaci\u00f3n econ\u00f3mica en medicina","volume":"122","author":"Sacrist\u00e1n JA","year":"2004","unstructured":"Sacrist\u00e1n JA, Ort\u00fan V, Rovira J, Prieto L, Garc\u00eda Alonso F. Evaluaci\u00f3n econ\u00f3mica en medicina. Med. Clin. (Barc) 122(10), 379\u2013382 (2004).","journal-title":"Med. Clin. (Barc)"},{"issue":"4","key":"e_1_3_6_19_2","doi-asserted-by":"crossref","first-page":"1181","DOI":"10.1007\/s00405-012-2139-8","article-title":"Cost-minimisation and cost-effectiveness analysis comparing transoral CO2 laser cordectomy, laryngofissure cordectomy and radiotherapy for the treatment of T1-2, N0, M0 glottic carcinoma","volume":"270","author":"Diaz-de-Cerio P","year":"2013","unstructured":"Diaz-de-Cerio P, Preciado J, Santaolalla F, Sanchez-Del-Rey A. Cost-minimisation and cost-effectiveness analysis comparing transoral CO2 laser cordectomy, laryngofissure cordectomy and radiotherapy for the treatment of T1-2, N0, M0 glottic carcinoma. Eur. Arch. Otorhinolaryngol. 270(4), 1181\u20131188 (2013).","journal-title":"Eur. Arch. Otorhinolaryngol."},{"issue":"9","key":"e_1_3_6_20_2","first-page":"822","article-title":"Methods for the economic evaluation of health care programmes, 3rd ed","volume":"60","author":"Adamiak G","year":"2006","unstructured":"Adamiak G. Methods for the economic evaluation of health care programmes, 3rd ed. J. Epidemiol. Community Health 60(9), 822\u2013823 (2006).","journal-title":"J. Epidemiol. Community Health"},{"issue":"4","key":"e_1_3_6_21_2","first-page":"277","article-title":"Eficacia del tratamiento quir\u00fargico del papiloma invertido nasosinusal","volume":"13","author":"Mart\u00ednez MM","year":"2022","unstructured":"Mart\u00ednez MM, Bosco G, Amarillo E Eficacia del tratamiento quir\u00fargico del papiloma invertido nasosinusal. Rev. ORL 13(4), 277\u2013287 (2022).","journal-title":"Rev. ORL"},{"issue":"3","key":"e_1_3_6_22_2","doi-asserted-by":"crossref","first-page":"2186","DOI":"10.1007\/s12070-019-01625-x","article-title":"Sinonasal inverted papilloma: efficacy of demucosation to reduce recurrence after surgical managements","volume":"71","author":"Ohki M","year":"2019","unstructured":"Ohki M, Kikuchi S. Sinonasal inverted papilloma: efficacy of demucosation to reduce recurrence after surgical managements. Indian J. Otolaryngol. Head Neck Surg. 71(Suppl. 3), 2186\u20132193 (2019).","journal-title":"Indian J. Otolaryngol. Head Neck Surg."},{"issue":"3","key":"e_1_3_6_23_2","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1177\/0194599819852104","article-title":"Evidence-based medicine in Otolaryngology part 10: cost-effectiveness analyses in Otolaryngology","volume":"161","author":"Caulley L","year":"2019","unstructured":"Caulley L, Rodin D, Kilty S, Randolph G, Hunink MG, Shin JJ. Evidence-based medicine in Otolaryngology part 10: cost-effectiveness analyses in Otolaryngology. Otolaryngol. Head Neck Surg. 161(3), 375\u2013387 (2019).","journal-title":"Otolaryngol. Head Neck Surg."},{"key":"e_1_3_6_24_2","volume-title":"M\u00e9todos para la evaluaci\u00f3n econ\u00f3mica de nuevas prestaciones","author":"Pinto Prades JL","year":"2003","unstructured":"Pinto Prades JL, S\u00e1nchez Mart\u00ednez FI. M\u00e9todos para la evaluaci\u00f3n econ\u00f3mica de nuevas prestaciones. Ministerio de Sanidad y Consumo, Madrid, Spain (2003)."},{"issue":"13","key":"e_1_3_6_25_2","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1016\/S0025-7753(04)74288-8","article-title":"An\u00e1lisis coste-efectividad en la evaluaci\u00f3n econ\u00f3mica de intervenciones sanitarias","volume":"122","author":"Prieto L","year":"2004","unstructured":"Prieto L, Sacrist\u00e1n JA, Anto\u00f1anzas F, Rubio-Terr\u00e9s C, Pinto JL, Rovira J. An\u00e1lisis coste-efectividad en la evaluaci\u00f3n econ\u00f3mica de intervenciones sanitarias. Med. Clin. 122(13), 505\u2013510 (2004).","journal-title":"Med. Clin."},{"issue":"3","key":"e_1_3_6_26_2","first-page":"231","article-title":"Health economics in rhinology: cost-effectiveness analyses in chronic rhinosinusitis and beyond","volume":"22","author":"Rudmik L","year":"2014","unstructured":"Rudmik L. Health economics in rhinology: cost-effectiveness analyses in chronic rhinosinusitis and beyond. Curr. Opin. Otolaryngol. Head Neck Surg. 22(3), 231\u2013236 (2014).","journal-title":"Curr. Opin. Otolaryngol. Head Neck Surg."},{"issue":"3","key":"e_1_3_6_27_2","doi-asserted-by":"crossref","first-page":"440","DOI":"10.1177\/0194599810391852","article-title":"Cost burden of chronic rhinosinusitis: a claims-based study","volume":"144","author":"Bhattacharyya N","year":"2011","unstructured":"Bhattacharyya N, Orlandi RR, Grebner J, Martinson M. Cost burden of chronic rhinosinusitis: a claims-based study. Otolaryngol. Head Neck Surg. 144(3), 440\u2013445 (2011).","journal-title":"Otolaryngol. Head Neck Surg."},{"issue":"9","key":"e_1_3_6_28_2","doi-asserted-by":"crossref","first-page":"748","DOI":"10.1002\/alr.21181","article-title":"Cost of outpatient endoscopic sinus surgery from the perspective of the Canadian government: a time-driven activity-based costing approach","volume":"3","author":"Au J","year":"2013","unstructured":"Au J, Rudmik L. Cost of outpatient endoscopic sinus surgery from the perspective of the Canadian government: a time-driven activity-based costing approach. Int. Forum Allergy Rhinol. 3(9), 748\u2013754 (2013).","journal-title":"Int. Forum Allergy Rhinol."},{"key":"e_1_3_6_29_2","doi-asserted-by":"crossref","first-page":"209","DOI":"10.2147\/CEOR.S410629","article-title":"Real-world cost of nasal polyps surgery and risk of major complications in the United States: a descriptive retrospective database analysis","volume":"15","author":"Ge W","year":"2023","unstructured":"Ge W, Wang D, Chuang CC Real-world cost of nasal polyps surgery and risk of major complications in the United States: a descriptive retrospective database analysis. Clinicoecon. Outcomes Res. 15, 209\u2013211 (2023).","journal-title":"Clinicoecon. Outcomes Res."},{"issue":"9","key":"e_1_3_6_30_2","doi-asserted-by":"crossref","first-page":"1969","DOI":"10.1002\/lary.27852","article-title":"Cost burden and resource utilization in patients with chronic rhinosinusitis and nasal polyps","volume":"129","author":"Bhattacharyya N","year":"2019","unstructured":"Bhattacharyya N, Villeneuve S, Joish VN Cost burden and resource utilization in patients with chronic rhinosinusitis and nasal polyps. Laryngoscope 129(9), 1969\u20131975 (2019).","journal-title":"Laryngoscope"}],"container-title":["Journal of Comparative Effectiveness Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/becarispublishing.com\/doi\/pdf\/10.57264\/cer-2025-0109","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T10:14:47Z","timestamp":1761905687000},"score":1,"resource":{"primary":{"URL":"https:\/\/becarispublishing.com\/doi\/10.57264\/cer-2025-0109"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11]]},"references-count":28,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2025,11]]}},"alternative-id":["10.57264\/cer-2025-0109"],"URL":"https:\/\/doi.org\/10.57264\/cer-2025-0109","relation":{},"ISSN":["2042-6305","2042-6313"],"issn-type":[{"type":"print","value":"2042-6305"},{"type":"electronic","value":"2042-6313"}],"subject":[],"published":{"date-parts":[[2025,11]]},"article-number":"e250109"}}