Division of Otolaryngology, Brigham and Women's Hospital, Boston, MA, USA.
Otolaryngol Head Neck Surg. 2011 Mar;144(3):440-5. doi: 10.1177/0194599810391852. Epub 2011 Feb 3.
To quantify the cost burden and utilization of health care for chronic rhinosinusitis (CRS).
Historical cohort study.
Academic medical centers.
Medical claims data from 2003 to 2008 were analyzed. Patients were defined as having chronic sinus disease if they had a minimum of 2 CRS-related diagnoses with either computed tomography scanning or endoscopy performed between diagnoses. The prevalence and costs of CRS from the payer perspective (reimbursements) were determined.
More than 4.4 million patients with an average of 3.1 years of eligibility and at least 1 diagnosis of acute rhinosinusitis (ARS) or CRS were studied. A total of 5.5% (95% confidence interval [CI], 5.4%-5.6%) of those with ARS were diagnosed with CRS in the subsequent 4 years. Among patients with chronic disease, after 12 months, 39% were still consuming care for CRS, and after 24 months, nearly 28% were still doing so. Of the CRS patients whose diagnosis was confirmed with endoscopy or radiology, 46.2% underwent endoscopic sinus surgery (ESS). In the year prior to ESS, patient care costs averaged $2449 ($2341-$2556). The ESS procedure plus 45-day postprocedure debridement and medical therapy costs averaged $7726 ($7554-$7898). In the year following the 45-day postprocedure period, consumption dropped by $885 (P < .0001). In the second year following ESS, therapy costs dropped an additional $446 (P < .0001).
A significant proportion of CRS patients require ongoing treatment of their sinus disease for years. Sinus surgery appears to reduce consumption of rhinosinusitis-related health care, but costs related to the procedure are significant.
量化慢性鼻-鼻窦炎（CRS）的医疗保健成本负担和利用情况。
历史队列研究。
学术医疗中心。
分析了 2003 年至 2008 年的医疗索赔数据。如果患者在两次诊断之间进行了至少 2 次 CRS 相关诊断（计算机断层扫描或内窥镜检查），则将其定义为患有慢性鼻窦疾病。从付款人角度（报销）确定 CRS 的患病率和成本。
研究了超过 440 万名平均有 3.1 年资格且至少有 1 次急性鼻-鼻窦炎（ARS）或 CRS 诊断的患者。在患有 ARS 的患者中，有 5.5%（95%置信区间[CI]，5.4%-5.6%）在随后的 4 年内被诊断为 CRS。在患有慢性疾病的患者中，在 12 个月后，仍有 39%的人在接受 CRS 治疗，在 24 个月后，仍有近 28%的人在接受治疗。在接受内窥镜或放射学检查以确认 CRS 诊断的患者中，有 46.2%接受了内窥镜鼻窦手术（ESS）。在 ESS 手术前一年，患者的护理费用平均为 2449 美元（2341-2556 美元）。ESS 手术加上术后 45 天清创术和药物治疗的费用平均为 7726 美元（7554-7898 美元）。在术后 45 天的治疗期结束后的一年中，费用下降了 885 美元（P<0.0001）。在 ESS 手术后的第二年，治疗费用又下降了 446 美元（P<0.0001）。
相当一部分 CRS 患者需要多年持续治疗鼻窦疾病。鼻窦手术似乎可以减少与鼻窦炎相关的医疗保健消费，但与该手术相关的成本却很高。
