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Lookup NU author(s): Tara HomerORCiD, Tony FouweatherORCiD, James O'HaraORCiD, Emerita Professor Janet WilsonORCiD, Professor Laura TernentORCiD
This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
© Author(s) (or their employer(s)) 2026. Re-use permitted under CC BY. Published by BMJ Group. This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.Objectives: To estimate the cost-effectiveness of immediate septoplasty compared with 6 months of medical management with the option for delayed septoplasty in individuals with nasal obstruction associated with septal deviation. Design: Economic evaluation alongside a multicentre, open label, randomised controlled trial. Setting: 17 otolaryngology clinics in the UK, recruiting from January 2018 to December 2019. Participants: Adults aged≥18 years with symptoms of nasal obstruction associated with septal deviation with at least moderate symptoms of nasal obstruction (score>30 on the Nasal Obstruction and Symptom Evaluation scale). Interventions: 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. Primary and secondary outcome measures: Incremental cost per quality-adjusted life year (QALY) gained at 12 months. 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 months. Sensitivity analyses were used to illustrate uncertainty. Results: In the within-trial analysis, immediate septoplasty was on average more costly (mean difference (95% CI) £1193 (£1018 to £1368)) and more effective (mean difference (95% CI) 0.044 QALYs (0.03 to 0.06)) when compared with 6 months of medical management with the option for deferred septoplasty. Immediate septoplasty had an incremental cost per QALY gained of £27 114 in the base case analysis, which decreased to £16 682 when micro-costing was used to estimate surgery costs. Immediate septoplasty had a 15% and 78% probability of being considered cost-effective at a £20 000 threshold for an additional QALY, respectively. In the model-based analysis, immediate septoplasty remained more costly and more effective than 6 months of medical management with the option for deferred septoplasty but had a 99% probability of being considered cost-effective at a £20 000 threshold for an additional QALY. Conclusions: Over a 24-month time horizon, immediate septoplasty would be cost-effective in the management of deviated nasal septum. Study registration: ISRCTN16168569.
Author(s): Homer T, Carrie S, Fouweather T, Teare D, Waugh N, O'Hara J, Wilson JA, Ternent L
Publication type: Article
Publication status: Published
Journal: BMJ Open
Year: 2026
Volume: 16
Issue: 7
Online publication date: 06/07/2026
Acceptance date: 28/04/2026
Date deposited: 04/08/2026
ISSN (electronic): 2044-6055
Publisher: BMJ Group
URL: https://doi.org/10.1136/bmjopen-2025-107402
DOI: 10.1136/bmjopen-2025-107402
Data Access Statement: Data are available upon reasonable request. The chief investigator and collaborators will act as custodians of the trial data and manage data sharing requests through ReShare, a UK online data repository recommended by the funder. Parties interested in data sharing will directly contact the chief investigator, Sean Carrie ‘ mailto: sean. carrie@ nhs. net’, and collaborators and complete a project proforma and provide the rationale and the information required and comply with the regulation of responsibilities of users. If agreed to be appropriate, requested anonymised data will be made available. An access advisor who is independent of the trial team will periodically review access decisions
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