Immediate Septoplasty More Cost-Effective Clinically Than Medical Management: Study
A new study published in the BMJ Open showed that for individuals with a deviated nasal septum, urgent septoplasty offers higher clinical benefit but is more expensive than medication treatment at long term follow up.
A deviated nasal septum creates airflow restriction. Although septoplasty surgery is commonly performed, proof for its superiority over medicinal alternatives like steroid sprays is scarce. The NAIROS randomized controlled study compares the economic value of urgent septoplasty to medical treatment. This report offers the final results of the economic evaluation.
From January 2018 to December 2019, 17 otolaryngology clinics in the UK included adults who were at least 18 years old and had at least significant nasal obstruction symptoms (score >30 on the Nasal Obstruction and Symptom Evaluation scale).
Participants were randomly assigned to have either septoplasty within 12 weeks of recruiting or medical care (saline spray and nasal steroids) for six months, with the option to postpone septoplasty. The additional cost per quality-adjusted life year (QALY) gained at 12 months was one of the primary and secondary outcome metrics. A tariff and micro-costing were used to estimate surgical expenses from the standpoint of the UK National Health Service.
When compared to six months of medical care with the option for postponed septoplasty, immediate septoplasty was, on average, more expensive and more successful in the within-trial analysis.
In the base case study, the extra cost per QALY gained by immediate septoplasty was £27 114. When surgical expenses were estimated using micro-costing, this amount dropped to £16 682.
At a £20,000 threshold for an extra QALY, immediate septoplasty had a 15% and 78% chance of being deemed cost-effective, respectively.
In the model-based study, immediate septoplasty had a 99% chance of being deemed cost-effective at a £20,000 threshold for an extra QALY, but it was still more expensive and more effective than six months of medical care with the option for deferred septoplasty.
Overall, the findings of the within-trial analysis show that immediate septoplasty is more cost-effective than 6 months of medical care with the option of deferred septoplasty. However, at 12 months, it is unclear whether treatment technique is best based on surgical cost estimates. At 24 months, immediate septoplasty is deemed cost-effective in managing a deviated nasal septum.
Source:
Homer, T., Carrie, S., Fouweather, T., Teare, D., Waugh, N., O’Hara, J., Wilson, J. A., & Ternent, L. (2026). Cost-effectiveness of immediate septoplasty versus medical management with the option for delayed septoplasty for nasal airways obstruction: a multicentre, open-label, randomised controlled trial. BMJ Open, 16(7), e107402. https://doi.org/10.1136/bmjopen-2025-107402
