Holy Chantal E, Ellison John M, Schneider Charles, Levine Howard L
Health Economics and Reimbursement, Menlo Park, CA, USA.
Medical Affairs, Acclarent Inc., a Johnson & Johnson Company, Menlo Park, CA, USA ; Cleveland Nasal-Sinus and Sleep Center, Cleveland, OH, USA.
Med Devices (Auckl). 2014 Apr 28;7:83-9. doi: 10.2147/MDER.S60054. eCollection 2014.
Endoscopic sinus surgery for patients with chronic rhinosinusitis (CRS) unresponsive to medical therapy has traditionally been performed under general anesthesia and in the operating room. Balloons for catheter dilation of paranasal sinuses were introduced in 2005, allowing sinus surgery to be safely performed either in the operating room or the office care setting, under local anesthesia. This change in care setting has raised concerns of overuse or expanded indications for sinus surgery. This study was thus designed to evaluate changes in surgical volumes in the United States, for the period 2006-2011, and to evaluate the impact of the sinus balloons on surgical practice.
The MarketScan(®) Commercial Claims and Encounter Database was queried for the period 2006 to 2011 using CRS International Classification of Diseases, Ninth Revision codes (473.X) and sinus surgery US-based Common Procedural Terminology (CPT) codes (endoscopic sinus surgery: CPT codes 31254-31294 and 31299; balloon catheter dilation: CPT codes 31295-31297). MarketScan's projection methodology was applied to estimate the nationwide prevalence of CRS and the incidence of sinus surgery. Procedural case mix and total average payment per surgery were analyzed.
From 2006 to 2011, the yearly prevalence of CRS and sinus surgery volume remained flat with ~430 patients with CRS per 100,000 in the employer-sponsored insured population, of which ~117/100,000 underwent surgery. In 2006, 2.69 paranasal sinuses (95% confidence interval [95% CI]: 2.65-2.71) were treated during each individual sinus surgery, with an additional 1.11 nasal procedures (95% CI: 1.08-1.13) performed concurrently. By 2011, the procedural case mix had expanded to 2.90 sinus (95% CI: 2.87-2.93) and 1.16 nasal procedures (95% CI: 1.14-1.85) per surgery. Payments increased from $7,011.06 (α=$6,378.30; β=3.1490) in 2006 to $9,090.11 (α=$8,350.20; β=2.9535) in 2011, in line with US medical inflation.
In the study population, approximately 1 in 3.7 patients diagnosed with CRS underwent sinus surgery. This ratio remained constant from 2006 to 2011. There was no evidence that the number of distinct sinus surgeries per 100,000 people increased despite the introduction and utilization of balloon catheter dilation tools that enabled migration of sinus surgery to the office.
传统上，慢性鼻窦炎（CRS）患者经药物治疗无效后接受的鼻内镜鼻窦手术是在全身麻醉下于手术室进行的。2005年引入了用于鼻窦导管扩张的球囊，使得鼻窦手术能够在局部麻醉下于手术室或门诊环境中安全进行。护理环境的这种变化引发了对鼻窦手术过度使用或适应症扩大的担忧。因此，本研究旨在评估2006 - 2011年期间美国手术量的变化，并评估鼻窦球囊对手术实践的影响。
利用CRS国际疾病分类第九版编码（473.X）以及美国鼻窦手术通用程序术语（CPT）编码（鼻内镜鼻窦手术：CPT编码31254 - 31294和31299；球囊导管扩张术：CPT编码31295 - 31297），对2006年至2011年期间的MarketScan®商业索赔和病历数据库进行查询。应用MarketScan的预测方法来估计全国CRS的患病率和鼻窦手术的发病率。分析了手术病例组合和每次手术的总平均费用。
从2006年到2011年，CRS的年患病率和鼻窦手术量保持平稳，在雇主赞助的参保人群中，每10万人约有430例CRS患者，其中约117/10万人接受了手术。2006年，每次鼻窦手术治疗2.69个鼻窦（95%置信区间[95%CI]：2.65 - 2.71），同时还进行1.11例鼻腔手术（95%CI：1.08 - 1.13）。到2011年，手术病例组合已扩大到每次手术2.90个鼻窦（95%CI：2.87 - 2.93）和1.16例鼻腔手术（95%CI：1.14 - 1.85）。费用从2006年的7,011.06美元（α = 6,378.30美元；β = 3.1490）增加到2011年的9,090.11美元（α = 8,350.20美元；β = 2.9535），与美国医疗通胀水平相符。
在研究人群中，每3.7例被诊断为CRS的患者中约有1例接受了鼻窦手术。这一比例在2006年至2011年期间保持不变。尽管引入并使用了使鼻窦手术能够转移到门诊的球囊导管扩张工具，但没有证据表明每10万人中进行的鼻窦手术数量增加。
