Impact of Endoscopic Sinus Surgery on Healthcare Use for Patients with Co-morbidities

Abstract

Objectives:

1) Analyze healthcare use of chronic rhinosinusitis (CRS) patients requiring endoscopic sinus surgery (ESS) based on co-morbidities (asthma, polyposis, and prior surgery) in an all-comer population. 2) Evaluate the effectiveness of ESS by sub-populations, using healthcare use pre- and post-surgery as a proxy for improvement.

Methods:

A retrospective database analysis was conducted using Marketscan. All patients with ESS (CPT 31254-31288) in 2008 and at least 5 years continuous enrollment (medical and drug coverage) were included (n=8,827). Patients were grouped based on diagnoses of asthma, polyposis, or prior surgery. In- and outpatient medical and prescription history for all sinonasal procedures or diagnoses was analyzed. All costs were calculated on a per-patient, per-quarter basis.

Results:

Total cost of care 9-12 months prior to surgery was: No comorbidity (NC): $195 (95% Confidence interval (95%CI) $178.24-$205.13), Polyps (P): $183.60 (95%CI $164.17-$203.03), Asthma (A): $484.56 (95%CI $443.30-$525.82), Asthma and Polyps (AP): $534 (95%CI $460.10-$609.80), and Revisions (R): $1,234.52 (95% CI $853.02-$1,616.01). Costs increased 1.5-3.5 fold prior to surgery (NC: $1,310.27, P: $1,358.11; A: $1,738.84, AP: $1,894.31, R: $1,782.03) and were followed by surgical costs ranging from $7,187.35-$9,650.83. ESS was consistently followed by significant drops in costs, which remained stable thereafter. Ongoing CRS disease costs at 2-year post-operative averaged between $195.36 (NC - 95%CI $172.66-$218.06) and $669.35 (AP - 95%CI $546.75-$791.94).

Conclusions:

Patients with asthma and polyps have ongoing disease costs approximately 3-fold greater than patients without those comorbidities. Prior to ESS, use increased significantly, reflecting unmanageable disease states in all patient subpopulations.