International Rhinologic Society Rhinology 0300-0729 2026 02 02 Regional disparities in cost-effectiveness of biologics for CRSwNP warrant tailored treatment strategies EN M. Xian Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China C. WangDepartment of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China L. ZhangDepartment of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China Letter 3368 10.4193/Rhin25.291 We read with great interest the recent study by Fieux et al. (1), which developed an evaluation model based on clinical practices, public health insurance, and private insurance systems in France. Through rigorous cost-effectiveness analysis, the authors concluded that initiating biologic therapy in patients with chronic rhinosinusitis with nasal polyps (CRSwNP) without previous endoscopic sinus surgery (ESS) imposes excessive economic burdens. This finding aligns with the current guideline regarding the indications for biological treatment in CRSwNP, which reserves biologics primarily for patients with prior ESS history.