Cost-Effective Management of Patients with Sinus Headache,Facial Pain,and Pressure: A Decision Analytic Approach

Abstract

Objectives:

1) To study patients presenting to a tertiary otolaryngology clinic with primary complaints of sinus headache, facial pain, and/or pressure. 2) To perform a computer-based decision analysis of these patients to maximize treatment effectiveness and minimize cost.

Methods:

A computer-based decision analytic approach was used to model cost-effectiveness (CE) of treatment of 253 adult patients presenting to a tertiary ear, nose, and throat (ENT) clinic over a two-year period. Chief complaints were sinus headache and/or facial pain/pressure. Analysis of demographics and treatment data was performed. Management was classified into three categories: 1) maximal medical therapy (MMT) alone, 2) MMT followed by endoscopic sinus surgery (ESS) due to refractory disease, and 3) referral to neurology for pain without apparent sinus etiology. Established treatment algorithms were integrated with CPT based treatment costs to create a 66-point decision tree that provides a comprehensive picture of CE of various modes of treatment for facial pain.

Results:

For patients without evidence of sinus disease, referral to neurology for facial pain saved $33.61 per patient for pain management. ESS resulted in a significant improvement in CE only with demonstrable sinus disease (C/E=26.37; p=0.027). Other trends observed include a non-significant reduction in cost and effectiveness of using MMT first in patients without clinical evidence of sinus disease (C/E=12.98; p=0.064).

Conclusions:

Our model demonstrates favorable CE of determining the etiology of facial pain as early as possible and proceeding with MMT or with referral to neurology, accordingly. ESS should only be offered to patients with true sinus disease refractory to MMT.