ENT & Allergy Associates, Seattle and Puyallup, Washington.
Department of Allergy, Kaiser Permanente, San Diego, California; Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California.
Clin Ther. 2022 Sep;44(9):1187-1202. doi: 10.1016/j.clinthera.2022.08.004. Epub 2022 Aug 31.
Nasal polyps (NPs) develop in 20% to 30% of patients with chronic rhinosinusitis. Severe forms of chronic rhinosinusitis with nasal polyposis (CRSwNP) may be treated with systemic corticosteroids (SCSs), which increase the risk for adverse clinical outcomes. This study compared the incidence of SCS-related adverse outcomes and health care resource utilization and costs between patients with CRSwNP who had SCS exposure and those who did not have SCS exposure.
This retrospective cohort study used health care claims data from adult patients with CRSwNP identified in the IBM MarketScan Databases between January 2003 and June 2019. The first SCS prescription date in SCS users or a matched date in SCS nonusers (controls) represented the index date. Enrollment for ≥1 year before and after the index date was required. SCS-related adverse outcomes and costs were compared between all SCS users and controls, and among subgroups of patients who had claims for 1-3 and ≥4 SCS prescriptions in the 12-month postindex period. Comparisons were also made among SCS users and controls who previously had and did not have NP surgery, and those with and without comorbid asthma. Inverse probability of treatment weights was applied to all comparisons, which were evaluated for a variable-length follow-up period.
SCS users (n = 37,740) had a greater risk for any adverse outcome than controls (n = 7032) (incidence rate ratio [IRR] = 1.10; 95% CI, 1.05-1.16). The risk for adverse outcomes was highest in the subgroups that did not have NP surgery and that had ≥4 SCS claims (n = 2993) versus controls who did not have NP surgery (n = 5078) (IRR = 1.30; 95% CI, 1.18-1.44). Similarly, patients with asthma and ≥4 SCS claims (n = 4195) had a greater risk for SCS-related outcomes versus controls with asthma (n = 1226) (IRR = 1.36; 95% CI, 1.19-1.55). SCS users incurred 60% higher all-cause costs versus non-SCS users (P < 0.001).
In patients with CRSwNP, SCS use was associated with a higher risk for adverse outcomes and with increased health care costs compared with controls without SCS exposure. Alternative treatment strategies that avoid and/or reduce SCS use may decrease health care costs and the risk for adverse outcomes among patients with CRSwNP.
鼻息肉（NPs）在 20%至 30%的慢性鼻-鼻窦炎患者中发展。伴有鼻息肉的慢性鼻-鼻窦炎（CRSwNP）的严重形式可能需要全身皮质类固醇（SCSs）治疗，这会增加不良临床结局的风险。本研究比较了有 SCS 暴露和无 SCS 暴露的 CRSwNP 患者 SCS 相关不良结局和医疗资源利用及成本。
这项回顾性队列研究使用了 2003 年 1 月至 2019 年 6 月间在 IBM MarketScan 数据库中识别的 CRSwNP 成年患者的医疗保健索赔数据。SCS 用户的第一次 SCS 处方日期或 SCS 非使用者（对照）的匹配日期（对照）代表索引日期。要求在索引日期前和后至少 1 年有登记。比较了所有 SCS 用户和对照组之间、以及在索引后 12 个月内有 1-3 次和≥4 次 SCS 处方的患者亚组之间的 SCS 相关不良结局和成本。还比较了以前有和没有 NP 手术的 SCS 用户和对照组，以及有和没有合并哮喘的患者。对所有比较都应用了治疗反概率权重，并评估了可变长度的随访期。
SCS 用户（n=37740）发生任何不良结局的风险高于对照组（n=7032）（发生率比[IRR]为 1.10；95%CI，1.05-1.16）。在没有 NP 手术和 SCS 索赔≥4 次的亚组中，风险最高（n=2993），与没有 NP 手术的对照组（n=5078）相比（IRR 为 1.30；95%CI，1.18-1.44）。同样，有哮喘且 SCS 索赔≥4 次的患者（n=4195）发生 SCS 相关结局的风险高于有哮喘的对照组（n=1226）（IRR 为 1.36；95%CI，1.19-1.55）。与非 SCS 用户相比，SCS 用户的所有原因成本高 60%（P < 0.001）。
在 CRSwNP 患者中，与无 SCS 暴露的对照组相比，SCS 使用与不良结局风险增加和医疗保健成本增加相关。避免和/或减少 SCS 使用的替代治疗策略可能会降低 CRSwNP 患者的医疗保健成本和不良结局风险。
