Hunter Tina D, DeConde Adam S, Manes R Peter
a CTI Clinical Trial and Consulting Services, Inc., Biostatistics & Health Outcomes Research , Covington , KY , USA.
b University of California-San Diego , San Diego , CA , USA.
J Med Econ. 2018 Jun;21(6):610-615. doi: 10.1080/13696998.2018.1452748. Epub 2018 Apr 3.
The objective of this study was to quantify the treatment costs and revision surgery rates in chronic rhinosinusitis (CRS) patients, with and without nasal polyposis (CRSwNP and CRSsNP), who require treatment with endoscopic sinus surgery (ESS). The additive contributions of nasal polyposis (NP) and revision surgery to 1-year costs were a primary focus.
Adults (aged 18-64 years) undergoing ESS for CRS in 2012-2015 were identified within the Blue Health Intelligence database and used to estimate revision rates. Patients with ±1 year of enrollment around the index ESS were used to estimate 1-year healthcare expenditures. Revision ESS rates were evaluated via Kaplan-Meier and Cox regression models. Disease-related healthcare and pharmacy expenditures were modeled with generalized linear regression to assess the impact of baseline patient characteristics.
A total of 86,052 patients underwent ESS for CRS (43.5 ± 12.4 years; 49.3% male), and a sub-set of 23,542 patients were available for 1-year healthcare expenditure analysis (44.0 ± 12.1 years; 50.0% male). Revision ESS rates within 1 year were 3.5% in the CRSwNP cohort and 1.6% in the CRSsNP cohort. NP, deviated septum, gender, and region were statistically significant predictors of revision surgery. Mean 1-year treatment expenditures, including the index ESS, were $8,824 for CRSsNP and $11,166 for CRSwNP patients without revision ESS. CRSwNP doubled the risk of revision surgery in the first year after ESS compared with CRSsNP and cost 24% more in the absence of a second procedure. Revision ESS within the first year increased mean 1-year expenditures by $11,150 and $13,139 for CRSsNP and CRSwNP, respectively.
The primary limitation was the limited length of follow-up available for estimating revision ESS rates.
In a large commercially insured US population, disease-related expenditures for patients having ESS for CRS are substantial, as are the additive impacts of NP and revision surgery.
本研究的目的是量化患有和未患有鼻息肉（伴鼻息肉慢性鼻窦炎和不伴鼻息肉慢性鼻窦炎）的慢性鼻窦炎（CRS）患者接受鼻内镜鼻窦手术（ESS）治疗的费用和翻修手术率。鼻息肉（NP）和翻修手术对1年费用的附加影响是主要关注点。
在Blue Health Intelligence数据库中识别出2012 - 2015年因CRS接受ESS的成年人（年龄18 - 64岁），并用于估计翻修率。以初次ESS为索引前后±1年入组的患者用于估计1年医疗保健支出。通过Kaplan - Meier和Cox回归模型评估翻修ESS率。使用广义线性回归对疾病相关的医疗保健和药房支出进行建模，以评估基线患者特征的影响。
共有86,052例患者因CRS接受了ESS（43.5 ± 12.4岁；49.3%为男性），其中23,542例患者的子集可用于1年医疗保健支出分析（44.0 ± 12.1岁；50.0%为男性）。伴鼻息肉慢性鼻窦炎队列1年内的翻修ESS率为3.5%，不伴鼻息肉慢性鼻窦炎队列中为1.6%。NP、鼻中隔偏曲、性别和地区是翻修手术的统计学显著预测因素。对于未进行翻修ESS的不伴鼻息肉慢性鼻窦炎患者，平均1年治疗支出（包括初次ESS）为8,824美元，伴鼻息肉慢性鼻窦炎患者为11,166美元。与不伴鼻息肉慢性鼻窦炎相比，伴鼻息肉慢性鼻窦炎在ESS后第一年翻修手术风险增加一倍，且在没有二次手术的情况下费用高出24%。第一年进行翻修ESS使不伴鼻息肉慢性鼻窦炎和伴鼻息肉慢性鼻窦炎的平均1年支出分别增加11,150美元和13,139美元。
主要局限性是可用于估计翻修ESS率的随访时间有限。
在美国大量商业保险人群中，因CRS接受ESS的患者与疾病相关的支出很高，NP和翻修手术的附加影响也是如此。
