Surgical therapy vs continued medical therapy for medically refractory chronic rhinosinusitis: a systematic review and meta‐analysis

Patel, Zara M.; Thamboo, Andrew; Rudmik, Luke; Nayak, Jayakar V.; Smith, Timothy L.; Hwang, Peter H.

doi:10.1002/alr.21872

Cited by 53 publications

(45 citation statements)

References 25 publications

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“…This reflects both the overall volume of patients utilizing these medications. The highest overall cost reductions were antibiotics (62.9%), followed by antihistamines (50.9%) and anti‐inflammatory agents (36.3%), yielding a total cost reduction across all drug categories of 34.2% or $3.9 M. These results mirror other studies showing similar reductions . Our look at cost effectiveness is intended to address whether the surgery defrays the additional costs and quality metrics associated with management of disease.…”

Section: Discussionsupporting

confidence: 55%

“…The highest overall cost reductions were antibiotics (62.9%), followed by antihistamines (50.9%) and anti-inflammatory agents (36.3%), yielding a total cost reduction across all drug categories of 34.2% or $3.9 M. These results mirror other studies showing similar reductions. [21][22][23][24][25][26] Our look at cost effectiveness is intended to address whether the surgery defrays the additional costs and quality metrics associated with management of disease. Our assessment specifically focused on metrics such as utilization and costs of prescription drug therapies, and office visits.…”

Section: Discussionmentioning

confidence: 99%

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A pathway to value‐based care of chronic rhinosinusitis using a claims database

Denneny

Cyr

Witsell

et al. 2018

Laryngoscope Investig Oto

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Objective To construct a comprehensive picture of the typical chronic rhinosinusitis (CRS) patient in the United States including the demographics, comorbidities, and geographic prevalence. The study will also identify the diagnostic and treatment regimens, their cost, and pattern of use for both medically and surgically managed patients. Study Design Historical cohort study utilizing private and public payer databases. Methods Medical claims data from the Truven Health MarketScan Research Databases from the years 2010 to 2012 for patients with acute rhinosinusitis (ARS) and CRS 18 and older were analyzed. Results There were 54 million unique patients in the databases from 2010 to 2012. Approximately 8 million had at least one diagnosis of ARS and 298,337 had a diagnosis of CRS. Females represented 63.7% of patients with ARS and 59.4% with CRS. Medicare patients represented 6.7% of the ARS population and 10.2% of the CRS population. The mean cost of a CRS episode for those commercially insured was $1024 and $762 in Medicare. CRS patients underwent diagnostic procedures including diagnostic endoscopy (55.1%), cultures (23.6%), sinus CT scan (82.1%) and MRI (0.2%). Endoscopic sinus surgery (ESS) was performed on 14.4% of those patients with CRS. Change in frequency of medication use from the 6 months prior to ESS to the 6 months post‐ESS yielded a reduction in total costs of 34.2% or $3.9 M. The most commonly operated sinuses (with or without septoplasty on same day as ESS) were the maxillary (94%/76.1%); followed by ethmoid (82.1%/66.6%); frontal (38.8%/35.1%); and sphenoid (28.5%/28.1%). In total, 16.6% had one sinus operated on, 39.1% had two, 24.6% had three, and 18.7% had four sinuses operated on. Conclusions This data paints a much clearer understanding of the current medical and surgical management. This study confirms the previously described “value proposition” for the surgical management of those CRS patients refractory to medical management. Level of Evidence 4

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Section: Discussionsupporting

confidence: 55%

Section: Discussionmentioning

confidence: 99%

A pathway to value‐based care of chronic rhinosinusitis using a claims database

Denneny

Cyr

Witsell

et al. 2018

Laryngoscope Investig Oto

View full text Add to dashboard Cite

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“…In addition to measures of fatigue and cognitive function, we sought to use the ctHPQ to assess changes in workplace productivity after initial AMT. Although several studies demonstrated the influence of CRS and its treatment on productivity, they typically examined the effects of continued AMT or surgical therapy as opposed to initial AMT . In the current study we failed to identify changes in absenteeism, presenteeism or relative pressenteeism, and job performance.…”

Section: Discussionmentioning

confidence: 54%

The impact of medical therapy on cognitive dysfunction in chronic rhinosinusitis

Rowan

Schlosser

Storck

et al. 2019

Int Forum Allergy Rhinol

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“…3,13 Such data has supported the utility of ESS for the treatment of appropriately selected patients with CRS. 8,11 However, published literature suggests wide variation in costs of ESS ranging from approximately $3,600 2016 USD in Canada, 6,14 to over $10,500 2016 USD in the U.S. 6 This wide variation may be due to much of the cost data for ESS being reported from the perspective of a third party payer, which ultimately reflects charges rather than costs. This also highlights the lack of data on the true costs of ESS and makes it difficult to define the true value of ESS.…”

Section: Introductionmentioning

confidence: 99%