A Scoping Review of Cost Analyses in Endoscopic Sinus Surgery: Economic Trends, Cost Drivers, and Methodological Gaps
Neha Rana, Daniel Swanson, Ethan Tsao, C. Scott Dorris, Raj Wasan, Daniel SpielmanABSTRACT
Objective
Endoscopic sinus surgery (ESS) is the standard surgical intervention for chronic rhinosinusitis (CRS), yet its economic value is not fully understood. This scoping review aims to synthesize economic evaluation of ESS, with emphasis on cost drivers, methodological approaches, and gaps in current literature.
Data Sources
This is a scoping review.
Review Methods
A scoping review was conducted in accordance with PRISMA‐ScR guidelines. A literature search was done using major databases (MEDLINE, Embase, Cochrane CENTRAL, Web of Science) from inception to July 2025. Studies were screened and selected based on predetermined inclusion criteria, and the data regarding study characteristics, economic methodology, and reported cost components were extracted.
Results
Of 1660 screened records, 35 studies met the inclusion criteria. Considerable heterogeneity was observed in study design, economic methodology, cost definitions, and reporting practices of the included studies. Across studies, operative time, surgical extent, and surgical setting were among the factors associated with variation in procedural costs. Indirect costs were inconsistently reported, while patient out‐of‐pocket costs were not explicitly evaluated.
Conclusion
Economic evaluations of ESS are highly heterogeneous, limiting direct comparison between studies. Although several studies reported favorable cost‐effectiveness estimates for ESS, methodological heterogeneity limits conclusions regarding its long‐term economic value. Standardized economic reporting frameworks are needed to improve comparability and clinical applicability.