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Rhinoplasty and Airway
When thinking about noses and Plastic Surgery, many people just think about looking better. But, what about breathing better? Plastic Surgeons are trained to treat the internal nose structures to improve airflow. These are important maneuvers during aesthetic rhinoplasty to minimize airway compromise while making the nose look better. However, these maneuvers (like septoplasty, turbinate reduction, and spreader grafts) may all be performed on patients who just cannot breathe well from their nose and are not concerned with nasal aesthetics. With pre approval, this surgery may even be covered by most health insurers. Take a look below at the highlights of a published article documenting that surgery is actually more cost effective in the long term versus nasal sprays and other medical management of poor nasal airflow. What if you do not like the looks of your nose and also have trouble breathing? Then, if you have an insurance pre approval, the cosmetic portion can just be added on at a significant cost reduction.
NEW YORK (Reuters Health) – Although surgery is costlier than use of a corticosteroid nasal spray in the short term in treating severe anatomical nasal obstruction, it is much more cost-effective in the long run, according to a post hoc retrospective study.
“In patients with physician-documented anatomic nasal obstruction, it is ultimately more cost-effective to have a surgical procedure than medical therapy,” senior author Dr. Sam P. Most of Stanford University School of Medicine in California told Reuters Health by email.
Insurance companies regularly require patients with nasal obstruction — even those with physician-documented anatomic obstruction — to undergo a trial of nasal steroid therapy, a treatment for nasal allergic disease.
But nasal sprays, typically used to treat nasal allergic disease, will not improve nasal obstruction rooted in an anatomical cause, such as severe septal deviations, Dr. Most pointed out.
“Thus, medical care is being dictated by insurers rather than medical evidence,” he said. “We sought to examine the cost-effectiveness of this strategy from the standpoint of the long-term effect on quality of life of our patients.”
The study, described by the authors as a cost-efficiency frontier economic evaluation, included 100 men and 79 women (mean age 37.9 years) presenting to Stanford’s facial plastic and reconstructive surgery clinic with a diagnosis of nasal airway obstruction, deviated nasal septum, and nasal valve stenosis between January 2011 and December 2013.
The study, the first of its kind, “has significant clinical implications for patients with nasal obstruction and the physicians who treat them, and could ultimately lead to shifts in the paradigm of care,” Dr. Lisa Ishii, of the Johns Hopkins University School of Medicine, Baltimore, told Reuters Health by email. (the study confirmed that in the presence of anatomic problem, surgery was more cost effective than medical therapy)
“The data presented in the study show that the current standard policy of requiring all patients with nasal obstruction to undergo medical therapy prior to undergoing surgery may actually unnecessarily delay appropriate treatment for a large subset of patients, those with severe to extreme nasal obstruction,” explained Dr. Ishii, who was not connected with the research.
“Despite our showing that from an incremental-cost-effectiveness ratio calculation, the surgical therapy is more cost effective, insurance companies only calculate how much they spend on each patient up front,” Dr. Most said. “Thus, any patient denied surgery is a plus for them.”
He said that he and his colleagues hope that their work “will stimulate other investigators to challenge some rules/regulations that are presumably being set up by insurers as ‘roadblocks’ to effective therapies.”
Mark D. Wigod, MD, FACS, providing Cosmetic and Reconstructive Plastic Surgery to Boise, Meridian, Treasure Valley and Southeastern Idaho.
