Denneny James C, Cyr Derek D, Witsell David L, Brereton Jean, Schulz Kristine
Department of Otolaryngology-Head and Neck Surgery Johns Hopkins School of Medicine Baltimore Maryland.
Duke Clinical Research Institute Durham, North Carolina.
Laryngoscope Investig Otolaryngol. 2018 Dec 28;4(1):193-206. doi: 10.1002/lio2.232. eCollection 2019 Feb.
To construct a comprehensive picture of the typical chronic rhinosinusitis (CRS) patient in the United States including the demographics, comorbidities, and geographic prevalence. The study will also identify the diagnostic and treatment regimens, their cost, and pattern of use for both medically and surgically managed patients.
Historical cohort study utilizing private and public payer databases.
Medical claims data from the Truven Health MarketScan Research Databases from the years 2010 to 2012 for patients with acute rhinosinusitis (ARS) and CRS 18 and older were analyzed.
There were 54 million unique patients in the databases from 2010 to 2012. Approximately 8 million had at least one diagnosis of ARS and 298,337 had a diagnosis of CRS. Females represented 63.7% of patients with ARS and 59.4% with CRS. Medicare patients represented 6.7% of the ARS population and 10.2% of the CRS population. The mean cost of a CRS episode for those commercially insured was $1024 and $762 in Medicare. CRS patients underwent diagnostic procedures including diagnostic endoscopy (55.1%), cultures (23.6%), sinus CT scan (82.1%) and MRI (0.2%). Endoscopic sinus surgery (ESS) was performed on 14.4% of those patients with CRS. Change in frequency of medication use from the 6 months prior to ESS to the 6 months post-ESS yielded a reduction in total costs of 34.2% or $3.9 M. The most commonly operated sinuses (with or without septoplasty on same day as ESS) were the maxillary (94%/76.1%); followed by ethmoid (82.1%/66.6%); frontal (38.8%/35.1%); and sphenoid (28.5%/28.1%). In total, 16.6% had one sinus operated on, 39.1% had two, 24.6% had three, and 18.7% had four sinuses operated on.
This data paints a much clearer understanding of the current medical and surgical management. This study confirms the previously described "value proposition" for the surgical management of those CRS patients refractory to medical management.
构建美国典型慢性鼻-鼻窦炎（CRS）患者的综合情况，包括人口统计学特征、合并症和地理患病率。该研究还将确定诊断和治疗方案、其成本以及药物治疗和手术治疗患者的使用模式。
利用私人和公共支付者数据库进行历史性队列研究。
分析了2010年至2012年来自Truven Health MarketScan研究数据库中18岁及以上急性鼻-鼻窦炎（ARS）和CRS患者的医疗理赔数据。
2010年至2012年数据库中有5400万独特患者。约800万患者至少有一次ARS诊断，298337例有CRS诊断。女性占ARS患者的63.7%，占CRS患者的59.4%。医疗保险患者占ARS人群的6.7%，占CRS人群的10.2%。商业保险患者CRS发作的平均费用为1024美元，医疗保险患者为762美元。CRS患者接受的诊断程序包括诊断性鼻内镜检查（55.1%）、培养（23.6%）、鼻窦CT扫描（82.1%）和MRI（0.2%）。14.4%的CRS患者接受了鼻内镜鼻窦手术（ESS）。从ESS前6个月到ESS后6个月药物使用频率的变化使总成本降低了34.2%或390万美元。最常进行手术的鼻窦（无论ESS当天是否进行鼻中隔成形术）是上颌窦（94%/76.1%）；其次是筛窦（82.1%/66.6%）；额窦（38.8%/35.1%）；蝶窦（28.5%/28.1%）。总共，16.6%的患者有一个鼻窦接受手术，39.1%有两个，24.6%有三个，18.7%有四个鼻窦接受手术。
这些数据使我们对当前的药物和手术治疗有了更清晰的认识。本研究证实了先前描述的对药物治疗无效的CRS患者进行手术治疗的“价值主张”。
4级。
