Gadkaree Shekhar K, Rathi Vinay K, Gottschalk Esther, Feng Allen L, Phillips Katie M, Scangas George A, Metson Ralph
Department of Otolaryngology, Harvard Medical School, Massachusetts Eye and Ear, Boston, Massachusetts, U.S.A.
Department of Otorhinolaryngology, University Medical Center of the Johannes Gutenberg-University, Mainz, Rhineland-Palatinate, Germany.
Laryngoscope. 2018 Jul;128(7):1540-1545. doi: 10.1002/lary.27203. Epub 2018 May 8.
Balloon dilation (BD) is a controversial alternative to conventional sinus surgery. The role of industry on practice patterns remains unknown. The aim of this study was to determine whether industry payments from BD manufacturers influence practice patterns for otolaryngologists and evaluate how these payments change over time.
Retrospective cohort study using Medicare Provider Utilization and Payment (PUP) Data and Center for Medicare and Medicaid Services Open Payments (OP) general payment datasets. A total of 294 otolaryngologists identified in the PUP dataset who performed BD procedures from January 1, 2013, to December 31, 2015, were cross-referenced in the OP dataset from January 1, 2014, to December 31, 2016, for BD manufacturer payments. Payments to surgeons performing BD stratified by amount, type, and number of procedures performed were primary outcome measures.
Of the 294 otolaryngologists reporting BD procedures, 223 (76%) received payments from a company that manufactures BD devices. Receipt of $2,500 in BD payments was associated with performance of one additional BD procedure, and consulting fees were most positively associated with performing additional BD procedures (P = 0.006). The providers receiving the most in BD payments were more likely to continue to receive the most in payments, regardless of number of BD procedures performed. Performing more BD procedures did not correlate with decrease in other sinus procedures.
Payments to otolaryngologists from manufacturers of sinus BD devices are associated with the performance of an increased number of such procedures. Surgeons should consider the impact of interactions with industry when evaluating patients for BD procedures.
球囊扩张术（BD）是传统鼻窦手术颇具争议的替代方案。行业因素在手术方式选择上所起的作用尚不明确。本研究旨在确定BD制造商支付给医生的费用是否会影响耳鼻喉科医生的手术方式选择，并评估这些费用随时间的变化情况。
采用回顾性队列研究，使用医疗保险提供者利用与支付（PUP）数据以及医疗保险和医疗补助服务中心公开支付（OP）通用支付数据集。在PUP数据集中识别出的294名在2013年1月1日至2015年12月31日期间进行BD手术的耳鼻喉科医生，于2014年1月1日至2016年12月31日在OP数据集中交叉对照BD制造商的支付情况。按支付金额、类型以及所实施手术数量分层的向实施BD手术的外科医生支付的费用是主要观察指标。
在报告进行BD手术的294名耳鼻喉科医生中，223名（76%）接受了BD设备制造商的支付。获得2500美元BD支付与多进行一例BD手术相关，且咨询费与多进行BD手术的关联最为显著（P = 0.006）。无论实施BD手术的数量多少，获得BD支付最多的医生更有可能继续获得最多的支付。进行更多的BD手术与其他鼻窦手术数量的减少并无关联。
鼻窦BD设备制造商向耳鼻喉科医生支付费用与此类手术数量的增加相关。外科医生在为患者评估BD手术时应考虑与行业互动的影响。
4。《喉镜》，2018年，第128卷，第1540 - 1545页。
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