Condition

Chronic Sinusitis

Long-term inflammation of the sinuses

400M
People Affected
60
Active Trials
40M
New Cases/Year
200
Deaths/Year

Treatment Rankings

Ranked by evidence volume first. Medicine has spent centuries ranking things by vibes. This is an improvement.

1
Dupilumab
90% Effectiveness• 92% Confidence• 72% Safety• 10 trials• 5K participants
HIGH EvidencePoor ValueDose: 300 mg subcutaneously every other week
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
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72
DangerousModerateSafe

Time to Effect

2-4 weeks

Duration

lifetime

Response Rate

85%

Remission Rate

40%

Number Needed to Treat (NNT)

3

Common Side Effects:

Injection site reactions: 15%
Conjunctivitis: 10%
Oral herpes: 3%

Annual Cost of Care

Drug Cost

$42,000

Monitoring

$300

Side Effects

$200

Total Annual

$42,500

Cost-Effectiveness

POOR

QALYs Gained

0.6

ICER

$250,000/QALY

Cost per Remission

$106,250

Cost per Responder

$50,000

Treatment Outcomes
Primary Outcomes
Nasal Polyp Score5.0/8 (0-8 scale)
-40% (-2.0 points)
Nasal Congestion Severity Score2.5/3 (0-3 scale)
-60% (-1.5 points)
Sino-Nasal Outcome Test-22 (SNOT-22)58/110 (0-110 scale)
-48.3% (-28 points)
Sense of Smell Score2.8/3 (0-3 severity scale)
-64.3% (-1.8 points)
Lund-Mackay CT Scan Score18/24 (0-24 scale)
-41.7% (-7.5 points)
Secondary Benefits
Annualized Systemic Corticosteroid Courses2.0 courses/year
-75% (-1.5 courses/year)
Blood Eosinophil Count500 cells/uL
-40% (-200 cells/uL)
Asthma Control Questionnaire (ACQ-5) Score2.5/6 (0-6 scale)
-32% (-0.8 points)
Common Side Effects
Injection site reactions
+15%
Conjunctivitis
+10%
Oral herpes
+3%

Clinical Trial Phases:

Phase 3Phase 4
2
Endoscopic Sinus Surgery (ESS)
88% Effectiveness• 90% Confidence• 60% Safety• 12 trials• 10K participants
HIGH EvidenceExcellent Value
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
60
DangerousModerateSafe

Time to Effect

4-8 weeks

Duration

one-time procedure (with ongoing medical therapy)

Response Rate

80%

Remission Rate

40%

Common Side Effects:

Post-operative pain: 85%
Nasal crusting: 40%
Minor bleeding: 15%
Infection: 3%

Annual Cost of Care

Drug Cost

$300

Monitoring

$500

Side Effects

$100

Total Annual

$2,900

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.4

ICER

$10,000/QALY

Cost per Remission

$7,250

Cost per Responder

$3,625

Treatment Outcomes
Primary Outcomes
SNOT-22 Score45/110 points
-60% (-27 points)
Endoscopic Lund-Kennedy Score10/24 points
-60% (-6 points)
Frequency of Acute Sinusitis Exacerbations4.5 episodes/year
-78% (-3.5 episodes/year)
Nasal Obstruction Visual Analog Scale (VAS)70/100 mm
-71% (-50 mm)
Secondary Benefits
Sniffin' Sticks Identification Test Score9/16 points (hyposmic)
+33% (+3 points)
Pittsburgh Sleep Quality Index (PSQI) Score10/21 points
-50% (-5 points)
Systemic Antibiotic Courses for CRS3 courses/year
-83% (-2.5 courses/year)
Common Side Effects
Post-operative pain
+85%
Nasal crusting
+40%
Minor bleeding
+15%
3
Oral Corticosteroids (short course)
85% Effectiveness• 88% Confidence• 55% Safety• 1 trials• 7K participants
HIGH EvidenceGood ValueDose: Prednisone 20-60mg daily, tapered
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
55
DangerousModerateSafe

Time to Effect

hours to days

Duration

5-21 days (tapering)

Response Rate

85%

Remission Rate

15%

Common Side Effects:

Insomnia: 15%
Mood changes: 10%
Increased appetite: 15%

Annual Cost of Care

Drug Cost

$40

Monitoring

$600

Side Effects

$100

Total Annual

$740

Cost-Effectiveness

GOOD

QALYs Gained

0.1

Cost per Remission

$933

Cost per Responder

$165

Treatment Outcomes
Primary Outcomes
SNOT-22 Score48 points (0-110 scale)
-33.3% (-16 points)
Nasal Congestion Severity7/10 (0-10 VAS)
-42.8% (-3 points (0-10 VAS))
Facial Pain/Pressure Severity6/10 (0-10 VAS)
-33.3% (-2 points (0-10 VAS))
Endoscopic Polyp Score5/8 (0-8 scale)
-40% (-2 points (0-8 scale))
Secondary Benefits
Sense of Smell (Perceived)4/10 (0-10 VAS)
+50% (+2 points (0-10 VAS))
Sleep Disturbance Severity7/10 (0-10 VAS)
-28.5% (-2 points (0-10 VAS))
Need for Rescue Medication3 times/day
-66.6% (-2 times/day)
Common Side Effects
Insomnia
+15%
Mood changes
+10%
Increased appetite
+15%

Clinical Trial Phases:

Phase 4
4
Topical Nasal Corticosteroids (e.g., Fluticasone Propionate)
80% Effectiveness• 95% Confidence• 83% Safety• 200 trials• 25K participants
HIGH EvidenceExcellent ValueDose: Fluticasone propionate 50-200 mcg per nostril daily
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
83
DangerousModerateSafe

Time to Effect

1-2 weeks

Duration

lifetime

Response Rate

70%

Remission Rate

25%

Number Needed to Treat (NNT)

6

Common Side Effects:

Nasal dryness: 10%
Epistaxis: 5%
Nasal irritation: 5%

Annual Cost of Care

Drug Cost

$300

Monitoring

$150

Side Effects

$50

Total Annual

$500

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.2

Cost per Remission

$2,000

Cost per Responder

$714

Treatment Outcomes
Efficacy Outcomes
Overall Effectiveness
+80%
Response Rate
+70%
Remission Rate
+25%
Common Side Effects
Nasal dryness
+10%
Epistaxis
+5%
Nasal irritation
+5%

Clinical Trial Phases:

Phase 4
5
Long-term Low-dose Macrolide Antibiotics (e.g., Azithromycin)
70% Effectiveness• 80% Confidence• 65% Safety• 35 trials• 6K participants
MODERATE EvidenceModerate ValueDose: Azithromycin 250mg 3 times per week
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
65
DangerousModerateSafe

Time to Effect

6-12 weeks

Duration

3-6 months

Response Rate

60%

Remission Rate

10%

Number Needed to Treat (NNT)

7

Common Side Effects:

Gastrointestinal upset: 15%
Hearing disturbances: 3%
QTc prolongation: 1%

Annual Cost of Care

Drug Cost

$300

Monitoring

$150

Side Effects

$100

Total Annual

$550

Cost-Effectiveness

MODERATE

QALYs Gained

0.15

Cost per Remission

$5,500

Cost per Responder

$917

Treatment Outcomes
Efficacy Outcomes
Overall Effectiveness
+70%
Response Rate
+60%
Remission Rate
+10%
Common Side Effects
Gastrointestinal upset
+15%
Hearing disturbances
+3%
QTc prolongation
+1%

Clinical Trial Phases:

Phase 4
6
Saline Nasal Irrigation
65% Effectiveness• 90% Confidence• 95% Safety• 29 trials• 8K participants
MODERATE EvidenceExcellent ValueDose: 1-2 rinses per day
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
95
DangerousModerateSafe

Time to Effect

immediate

Duration

lifetime

Response Rate

60%

Remission Rate

5%

Number Needed to Treat (NNT)

8

Common Side Effects:

Nasal dryness: 2%
Nasal irritation: 1%

Annual Cost of Care

Drug Cost

$200

Monitoring

$600

Side Effects

$0

Total Annual

$800

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.1

Cost per Remission

$4,000

Cost per Responder

$333

Treatment Outcomes
Primary Outcomes
Sino-Nasal Outcome Test (SNOT-22) Score45/110
-40% (-18 points)
Nasal Congestion Severity (0-10 VAS)7/10
-35.7% (-2.5 points)
Post-Nasal Drip Severity (0-10 VAS)6/10
-33.3% (-2 points)
Facial Pain/Pressure Severity (0-10 VAS)5/10
-30% (-1.5 points)
Secondary Benefits
General Health-Related Quality of Life (EQ-5D Index Score)0.65
+15.4% (+0.10)
Frequency of Acute Exacerbations per Year4 exacerbations/year
-37.5% (-1.5 exacerbations/year)
Antibiotic Courses for Sinusitis per Year2 courses/year
-50% (-1 course/year)
Common Side Effects
Nasal dryness
+2%
Nasal irritation
+1%