Cost burden and resource utilization in patients with chronic rhinosinusitis and nasal polyps

Abstract

Objectives/hypothesis: Establish treatment patterns and economic burden in US patients with chronic rhinosinusitis with nasal polyposis (CRSwNP) versus without chronic rhinosinusitis (CRS). Determine comparative costs of subgroups with high clinical burden.

Study design: Observational, retrospective, case-control study.

Methods: This study matched patients with CRSwNP to patients without CRS (1:1) using the Truven Health MarketScan US claims database. Categorical and continuous variables were compared using McNemar test and paired t test (normal distribution) or Wilcoxon signed rank tests (non-normal distribution). Within subgroups, χ² and Wilcoxon or t tests were used (normal distribution).

Results: There were 10,841 patients with CRSwNP and 10,841 patients without CRS included. Mean age in the CRSwNP cohort was 45.8 years; 56.2% were male. During follow-up, patients with CRSwNP had an increased diagnosis of asthma versus patients without CRS (20.8% vs. 8.1%, respectively; P < .001). Annual incremental costs were $11,507 higher for patients with CRSwNP versus those without CRS. Costs were higher in subgroups of patients with CRSwNP undergoing functional endoscopy sinus surgery (FESS), with a comorbid diagnosis of asthma, receiving oral corticosteroids, or macrolides versus the overall CRSwNP group. Patients with CRSwNP undergoing FESS had the highest costs of the four subgroups ($26,724, $22,456, $20,695, and $20,990, respectively).

Conclusions: Annual incremental costs were higher among patients with CRSwNP versus without CRS. Patients with CRSwNP with high clinical burden had higher overall costs than CRSwNP patients without.

Level of evidence: NA Laryngoscope, 129:1969-1975, 2019.

Keywords: Disease burden; chronic rhinosinusitis with nasal polyposis; cost of illness; economic burden; healthcare resource utilization.

Figure 1

Difference in healthcare costs between patients with chronic rhinosinusitis with nasal polyposis and controls at follow‐up. *Office costs and ambulatory costs make up medical costs. CRSwNP = chronic rhinosinusitis with nasal polyps; IC = incremental costs; USD = United States dollars.

Figure 2

Mean annual healthcare costs among patients with chronic rhinosinusitis with nasal polyposis. (A) Undergoing and not undergoing functional endoscopic sinus surgery. (B) With and without asthma. (C) Receiving and not receiving oral corticosteroids. (D) Receiving and not receiving macrolides. CRSwNP = chronic rhinosinusitis with nasal polyposis; IC = incremental costs; USD = United States dollar *Office costs and ambulatory costs make up medical cost.