The extra cost of biologics as first-line treatment in uncontrolled chronic rhinosinusitis with nasal polyps with no previous sinus surgery is overwhelming: a budget impact analysis

Background: Both surgery and biologics offer comparable control rates for patients with uncontrolled chronic rhinosinusitis with nasal polyps (CRSwNP) but differ in terms of cost and complications. The aim was to assess the mean total direct cost per patient of biologics or surgery as first-line treatment in uncontrolled CRSwNP and to perform a budget impact analysis (BIA). Methods: An economic model was build based on pricing of March 2024, and on the theoretical French population to simulate both the 5-year mean direct cost per patient and the BIA. For the BIA, two scenarios were evaluated: in scenario 1 (the normal one), 18% of patients received biologics as first-line (vs 82% surgery) and in scenario 2 (the less likely one), 90% of patients received biologics as first-line (vs 10% surgery). Within both scenarios, two approaches were considered, the surgical one (when patients received surgery as first-line) and the biological one (when patients received biologics as first-line, no previous sinus surgery). Results: Over 5 years, the estimated mean direct cost per patient per year was significantly lower in the surgical approach compared to the biological one (60,026€). The BIA found that the estimated net overall incremental budget impact was 91,287,924€ in scenario 1 and 1,024,768,639€ in scenario 2. In both scenarios, the biological approach was the most expensive (+184% and +1048%, respectively). Conclusion: At current costs, if biologics were used as a first-line treatment (no previous sinus surgery) in patients with uncontrolled CRSwNP, the extra direct cost would be overwhelming.