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

Area of Science:

• Otolaryngology
• Health Economics
• Epidemiology

Background:

• Chronic rhinosinusitis (CRS) is a prevalent condition impacting millions in the U.S.
• Understanding the characteristics of CRS patients is crucial for effective healthcare management.
• Current treatment paradigms for CRS involve both medical and surgical interventions with varying cost implications.

Purpose of the Study:

• To delineate the demographic profile, comorbidities, and geographic distribution of typical chronic rhinosinusitis patients in the United States.
• To identify and analyze the diagnostic and treatment strategies employed for CRS patients.
• To evaluate the cost-effectiveness and utilization patterns of medical and surgical management for CRS.

Main Methods:

• A historical cohort study design was employed.
• Analysis of medical claims data from private and public payer databases (Truven Health MarketScan Research Databases) spanning 2010-2012.
• Inclusion criteria: patients aged 18 and older with diagnoses of acute rhinosinusitis (ARS) or CRS.

Main Results:

• The study analyzed data from 54 million unique patients, identifying 298,337 with CRS.
• Females constituted 59.4% of the CRS population, with Medicare patients representing 10.2%.
• Endoscopic sinus surgery (ESS) was performed on 14.4% of CRS patients, leading to a 34.2% reduction in total costs post-surgery. Maxillary sinuses were most frequently operated on (94%).

Conclusions:

• The study provides a comprehensive overview of the contemporary medical and surgical management of chronic rhinosinusitis in the U.S.
• Surgical intervention demonstrates a clear "value proposition" for CRS patients who have not responded to medical therapy.
• Further research can refine treatment protocols and resource allocation for CRS management.