Healthcare Utilization After Biologic Initiation for Chronic Rhinosinusitis

BackgroundBiologic therapies for chronic rhinosinusitis with nasal polyps (CRSwNP) broaden options beyond endoscopic sinus surgery (ESS) and conventional medications. However, the short-term impact of biologic therapy on healthcare utilization relative to ESS is unclear.ObjectiveTo compare 12-month healthcare utilization and costs after biologic initiation versus ESS.MethodsUsing the Atropos Health platform (2019-2024; ∼66 million patients), adults with CRSwNP and ≥12-month follow-up who received treatment with ESS or an approved biologic were identified. After 1:1 propensity-score matching, 12-month outcomes were compared, including medication use, CRSwNP-related visits, subsequent sinus surgery, complications, and Current Procedural Terminology (CPT)-based costs.ResultsOf 7519 ESS and 2084 biologic-treated eligible patients, 998 remained per arm after matching. Biologics and ESS patients had similar office (41.3% vs 38.7%; OR 0.90, 95% CI 0.77-1.07) and ED visit rates (2.0% vs 1.3%; OR 0.65, 95% CI 0.32-1.30). Subsequent sinus surgery was more frequent after biologics (3.6% vs 12.9%; OR 3.97, 95% CI 2.71-5.80). No significant differences were identified in CPT-based costs, complication rates, or steroid use.ConclusionsWithin 1 year, ESS and biologic patients showed similar healthcare utilization, with the exception of subsequent sinus surgery rates, which were higher in biologic patients. These findings may guide shared decision-making and payer policy.