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Healthcare Utilization After Biologic Initiation for Chronic Rhinosinusitis
Beau M Idler1, Jananee Muralidharan2, Gavin Hui2
1Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA.
American Journal of Rhinology & Allergy
|August 5, 2026
Summary
Biologic therapy and endoscopic sinus surgery (ESS) for chronic rhinosinusitis with nasal polyps (CRSwNP) show similar healthcare use. However, biologic patients had more repeat surgeries within one year.
Area of Science:
- Otolaryngology
- Immunology
- Health Services Research
Background:
- Biologic therapies offer new treatment avenues for chronic rhinosinusitis with nasal polyps (CRSwNP), complementing endoscopic sinus surgery (ESS) and traditional medications.
- The immediate impact of biologic treatments on healthcare utilization compared to ESS remains incompletely understood.
Purpose of the Study:
- To compare 12-month healthcare utilization and associated costs between patients receiving biologic therapy and those undergoing ESS for CRSwNP.
Main Methods:
- A retrospective analysis of approximately 66 million patients from the Atropos Health platform (2019-2024) identified adults with CRSwNP treated with ESS or biologics.
- Propensity-score matching (1:1) was employed to create comparable cohorts for analyzing 12-month outcomes, including medication use, CRSwNP-related visits, subsequent surgeries, complications, and costs.
- Outcomes were assessed for 998 patients in each group (ESS vs. biologics) post-matching.
Main Results:
- Office and emergency department visit rates were comparable between the biologic and ESS groups.
- Patients treated with biologics experienced a significantly higher rate of subsequent sinus surgery compared to those who underwent ESS (12.9% vs. 3.6%).
- No significant differences were observed in overall healthcare costs, complication rates, or corticosteroid use between the two treatment arms.
Conclusions:
- Within one year, patients with CRSwNP treated with biologics or ESS demonstrated similar healthcare utilization patterns, excluding subsequent sinus surgery rates.
- The higher incidence of repeat surgeries in the biologic group warrants consideration in treatment decisions and healthcare policy.
- Findings support informed shared decision-making between patients and clinicians regarding CRSwNP management strategies.
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