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Background The purpose of this work was to evaluate the cost‐effectiveness of endoscopic sinus surgery (ESS) compared to medical therapy for patients with chronic rhinosinusitis (CRS). Methods The study design consisted of a microsimulation Markov decision‐tree economic model with a 31‐year time horizon. A cohort of 489 patients who underwent ESS for CRS were matched 1 to 1 with a cohort of 489 patients from the national Medical Expenditures Panel Survey database who underwent medical management for CRS. Utility scores were calculated from responses to the EuroQol 5‐Dimension instrument in both cohorts. Decision‐tree analysis and a subsequent 10‐state Markov model utilized published event probabilities as well as primary data from a large multisurgeon prospective outcomes study to calculate long‐term costs and utility. The primary outcome measure was incremental cost per quality …