Chronic rhinosinusitis with nasal polyps (CRSwNP) compromises respiratory function, sleep, concentration, work capacity, and quality of life, generating high costs for patients and health systems. The aim of the study was to analyze the cost utility of Dupilumab compared to endoscopic sinus surgery for patients with CRSwNP.We developed a model-based cost-utility analysis from the perspective of the Colombian health system to compare Dupilumab vs. endoscopic nasal surgery in patients with difficult-to-treat CRSwNP. Transition probabilities were extracted from the published literature about CRSwNP, and costing was based on local tariffs. We performed probabilistic sensitivity analysis for outcomes, probabilities, and costs (10.000 Monte Carlo simulations).The cost of dupilumab ($ 142.919) was 7.8 times higher than nasal endoscopic sinus surgery ($ 18.347). In terms of quality-adjusted life years (QALYs), surgery generates better results than Dupilumab: 11.78 vs. 9.05 QALYs.From the perspective of the health system, endoscopic sinus surgery for the management of CRSwNP is a dominant alternative in all the analyzed scenarios compared to the use of Dupilumab. From a cost-utility point of view, the use of dupilumab should be considered when the patient requires multiple surgeries or when there is a contraindication for surgery performance.