Endoscopic Sinus Surgery Provides Effective Relief as Demonstrated by Pre- and Post-operative Healthcare Use

Abstract

Objectives:

Analyze the impact of endoscopic sinus surgery (ESS) on overall healthcare use for treatment of chronic rhinosinusitis (CRS), and evaluate the effectiveness of ESS based on pre- and post-operative healthcare use.

Methods:

A retrospective database analysis was conducted using Marketscan. All patients with ESS (CPT 31254-31288) in 2008 and at least 5 years continuous medical and drug plan enrollment were included (n=8,827). In- and outpatient medical history including prescriptions but excluding pain medication (potentially less disease-specific) for all sinonasal procedures or diagnoses was analyzed. All costs were determined on a per-patient, per-quarter basis, from 4 quarters pre-surgery to 8 quarters post-surgery.

Results:

During the 4th quarter pre-surgery (9-12 months pre-operative), healthcare use included ~1.95 prescriptions (95% confidence interval [CI] 1.89-2.00), 1.92 visits or procedures per patient (95%CI: 1.83-2.01), and total average cost of US$ 399.10 (95%CI: US$391.24-US$406.96). These costs increased significantly within 2 months pre-operatively to $1,523.41, including 3.75 prescriptions (95%CI: 3.68-3.81). The cost of ESS and related medical care for 90-day post-op averaged $8,521.87 (95%CI: $8,505.16-$8,538.58). By the 15th month post-operative, healthcare costs dropped to $363.68 (95%CI: $355.77-371.59), with 1.98 prescriptions (95% CI: 1.93-2.04) and remained flat for the remainder of the follow-up period. Cost of all drug categories declined post-operatively, except for leukotriene modifiers.

Conclusions:

Immediately prior to ESS, patients’ healthcare needs increased approximately 4-fold. Within 15 months post-surgery, however, costs were statistically lower than observed 12 months pre-surgery. These findings suggest that ESS may have provided timely management of a severe and unsustainable disease state.