Abstract
Chronic rhinosinusitis (CRS) is an under-recognized and highly prevalent chronic disease affecting 5–15 % of the population. Recently, there has been a growing awareness of the significant economic burden associated with the long-term medical and surgical management of CRS. In the context of exponentially increasing and unsustainable health care spending, there is an urgent need to better define the costs associated with the care of these patients in order to develop treatment strategies that increase the quality and value of care to patients. This review will provide readers with an introduction to health care costs then discuss the costs associated with the management of CRS, emphasizing key studies that have defined these costs. Understanding the sources of these costs is a crucial first step towards eventually improving the value of care for this ubiquitous chronic inflammatory disease.
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References
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
Porter ME. A strategy for health care reform—toward a value-based system. N Engl J Med. 2009;361(2):109–12.
•• Porter ME. What is value in health care? N Engl J Med 2010:363(26):2477–81. This is an excellent article describing the concepts involved in increasing ‘value’ in health care. It defines value and outlines potential strategies to create the correct type of competition, which is based on patients outcomes, to improve value of health care interventions.
Liu CC, et al. Systematic review of the quality of economic evaluations in the otolaryngology literature. Otolaryngol Head Neck Surg. 2015;152:106–15.
• Smith KA, Rudmik L. Cost collection and analysis for health economic evaluation. Otolaryngol Head Neck Surg 2013:149(2):192–9. This is an important review to improve the understanding of how to appropriately collect, report, and interpret cost outcomes within the context of health care delivery. The information is particularly helpful for investigators wishing to perform a health economic evaluation.
Berger M, et al. Health care cost, quality and outcomes: ISPOR book of terms 2003. Lawrenceville: International Society for Pharmacoeconomics and Outcomes Research; 2003.
Halawi AM, Smith SS, Chandra RK. Chronic rhinosinusitis: epidemiology and cost. Allergy Asthma Proc. 2013;34(4):328–34.
Rudmik L, Smith TL. Quality of life in patients with chronic rhinosinusitis. Curr Allergy Asthma Rep. 2011;11(3):247–52.
Soler ZM, et al. Health state utility values in patients undergoing endoscopic sinus surgery. Laryngoscope. 2011;121(12):2672–8.
Alt JA, Smith TL. Chronic rhinosinusitis and sleep: a contemporary review. Int Forum Allergy Rhinol. 2013;3(11):941–9.
Alt JA, et al. Sleep quality and disease severity in patients with chronic rhinosinusitis. Laryngoscope. 2013;123(10):2364–70.
Soler ZM, Mace J, Smith TL. Symptom-based presentation of chronic rhinosinusitis and symptom-specific outcomes after endoscopic sinus surgery. Am J Rhinol. 2008;22(3):297–301.
Rank MA, et al. Acute exacerbations of chronic rhinosinusitis occur in a distinct seasonal pattern. J Allergy Clin Immunol. 2010;126(1):168–9.
Chester AC, et al. Systematic review of change in bodily pain after sinus surgery. Otolaryngol Head Neck Surg. 2008;139(6):759–65.
Kang JH, et al. Chronic rhinosinusitis increased the risk of stroke: a 5-year follow-up study. Laryngoscope. 2013;123(4):835–40.
Wu CW, et al. Risk of stroke among patients with rhinosinusitis: a population-based study in Taiwan. Am J Rhinol Allergy. 2012;26(4):278–82.
Kariya S, et al. Chronic rhinosinusitis patients have decreased lung function. Int Forum Allergy Rhinol. 2014;4(10):828–33.
Katotomichelakis M, et al. Demographic correlates of anxiety and depression symptoms in chronic sinonasal diseases. Int J Psychiatry Med. 2014;48(2):83–94.
Tomljenovic D, Pinter D, Kalogjera L. Perceived stress and severity of chronic rhinosinusitis in allergic and nonallergic patients. Allergy Asthma Proc. 2014;35(5):398–403.
• Bhattacharyya N. Incremental health care utilization and expenditures for chronic rhinosinusitis in the United States. Ann Otol Rhinol Laryngol 2011:120(7):423–7. The results from this large administrative database research study have provided the most accurate overall direct cost of CRS to the US health care system. It demonstrated an annual overall direct health care cost of $8.6 billion (adjusted 2014 USD $9.9 billion).
• Rudmik L, et al. Productivity costs in patients with refractory chronic rhinosinusitis. Laryngoscope 2014:124(9):2007–12. This is the first prospective study quantifying the indirect costs of patients with refractory CRS. It demonstrated that the annual productivity cost was approximately $10,000 per patient and an overall indirect cost of $12 billion to the US society.
Benninger MS, Holy CE. Endoscopic sinus surgery provides effective relief as observed by health care use pre- and postoperatively. Otolaryngol Head Neck Surg. 2014;150(5):893–900.
Benninger MS, Holy CE. The impact of endoscopic sinus surgery on health care use in patients with respiratory comorbidities. Otolaryngol Head Neck Surg. 2014;151(3):508–15.
Gliklich RE, Metson R. Economic implications of chronic sinusitis. Otolaryngol Head Neck Surg. 1998;118(3 Pt 1):344–9.
Holy CE, et al. The impact of balloon catheter dilation on frequency of sinus surgery in the United States. Med Devices (Auckl). 2014;7:83–9.
Chung SD, et al. Health care service utilization among patients with chronic rhinosinusitis: a population-based study. Laryngoscope. 2014;124(6):1285–9.
Bhattacharyya N. The economic burden and symptom manifestations of chronic rhinosinusitis. Am J Rhinol. 2003;17(1):27–32.
Bhattacharyya N, et al. Cost burden of chronic rhinosinusitis: a claims-based study. Otolaryngol Head Neck Surg. 2011;144(3):440–5.
Au J, Rudmik L. Cost of outpatient endoscopic sinus surgery from the perspective of the Canadian government: a time-driven activity-based costing approach. Int Forum Allergy Rhinol. 2013;3(9):748–54.
Chatterjee S, Laxminarayan R. Costs of surgical procedures in Indian hospitals. BMJ Open. 2013;3:6.
Rudmik L, et al. Economic evaluation of endoscopic sinus surgery versus continued medical therapy for refractory chronic rhinosinusitis. Laryngoscope. 2015;125:25–32.
Weinstein MC. How much are Americans willing to pay for a quality-adjusted life year? Med Care. 2008;46(4):343–5.
Shiroiwa T, et al. International survey on willingness-to-pay (WTP) for one additional QALY gained: what is the threshold of cost effectiveness? Health Econ. 2010;19(4):422–37.
•• Rudmik L, Drummond M. Health economic evaluation: important principles and methodology. Laryngoscope 2013;123(6):1341–7. With increasing emphasis being placed onto the value and cost-effectiveness of medical and surgical interventions, clinicians need to obtain knowledge of economic evaluation methodology and interpretation. This article is an excellent resource to review basic cost-effectiveness analysis, health-state utility metrics, controversies with using the quality-adjusted life year, and common pitfalls.
Hanna BM, Kilty SJ. Middle turbinate suture technique: a cost-saving and effective method for middle meatal preservation after endoscopic sinus surgery. J Otolaryngol Head Neck Surg. 2012;41(6):407–12.
Rudmik L, Smith TL. Economic evaluation of a steroid-eluting sinus implant following endoscopic sinus surgery for chronic rhinosinusitis. Otolaryngol Head Neck Surg. 2014;151(2):359–66.
Yeh DH, et al. The utility of routine polyp histopathology after endoscopic sinus surgery. Int Forum Allergy Rhinol. 2014;4:11.
Desrosiers M, et al. Canadian clinical practice guidelines for acute and chronic rhinosinusitis. J Otolaryngol Head Neck Surg. 2011;40(Suppl 2):S99–193.
Fokkens WJ, et al. EPOS 2012: European position paper on rhinosinusitis and nasal polyps 2012. A summary for otorhinolaryngologists. Rhinology. 2012;50(1):1–12.
Rosenfeld RM, et al. Clinical practice guideline: adult sinusitis. Otolaryngol Head Neck Surg. 2007;137(3 Suppl):S1–31.
Leung RM, et al. Primary care and upfront computed tomography scanning in the diagnosis of chronic rhinosinusitis: a cost-based decision analysis. Laryngoscope. 2014;124(1):12–8.
Tan BK, et al. Effect of symptom-based risk stratification on the costs of managing patients with chronic rhinosinusitis symptoms. Int Forum Allergy Rhinol. 2013;3(11):933–40.
Akdis CA, et al. Endotypes and phenotypes of chronic rhinosinusitis: a PRACTALL document of the European Academy of Allergy and Clinical Immunology and the American Academy of Allergy, Asthma & Immunology. J Allergy Clin Immunol. 2013;131(6):1479–90.
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Smith, K.A., Rudmik, L. Update on the Costs of Chronic Rhinosinusitis. Curr Otorhinolaryngol Rep 3, 87–93 (2015). https://doi.org/10.1007/s40136-015-0076-y
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DOI: https://doi.org/10.1007/s40136-015-0076-y