Advice

Expert comments

Expert comments

Comments on this technology were invited from clinical experts working in the field and relevant patient organisations. The comments received are individual opinions and do not represent NICE's view.

All 3 experts were familiar with or had used this technology before.

Level of innovation

Two experts considered the technology to be novel. The other expert considered it a minor variation which is unlikely to alter the procedure's safety and efficacy. One of those who considered it novel identified Acclarent as its closest comparative treatment, but noted this had been withdrawn from the UK.

Potential patient impact

The experts identified potential patient benefits as less:

  • sinus stenosis

  • need for postoperative local care

  • development of early postoperative recurrent polyposis in people with polyps

  • revision surgery.

Patients with rapidly recurring polyps, recurrent chronic sinus disease, and severe eosinophilic chronic sinusitis were identified as subgroups who would particularly benefit from this technology.

Potential system impact

Fewer hospital visits and less revision surgery, and enabling a shift to tertiary centres were identified as potential system benefits.

General comments

When asked about the cost consequences of adopting the technology 1 expert noted that it would cost more initially. The other experts said that it could save more or be cost neutral, but this was based on projections with uncertainties. There were mixed estimates of the population in whom the technology would be used ranging from 5% up to 30% of those with chronic sinusitis who need surgery. The experts said training was needed to use PROPEL but this was minimal. They noted that no additional facilities were needed to use PROPEL. In terms of safety they noted the adverse events reported in the papers: migration of the device, fungal infections and adverse reactions to corticosteroid. The experts said that uncertainties and concerns were: cost, efficacy compared with absorbable packing soaked in steroids, stability of fixation of the implant and potential for misplacement.