Economic Impact Associated with a Reduction in Surgical Eligibility among Adult Patients with Chronic Rhinosinusitis - A Population Cost Offset Model
Sunday, March 4, 2018
South Hall A2 (Convention Center)
Nate J. Smith, PhD, Fulton F. Velez, MD, Emmanuel M. Mahlis, MD, Joseph J. Medicis, PharmD, John C. Messina Jr., PharmD, Rachel A. Beckerman, PhD, Joseph Gricar, MS, Ramy A. Mahmoud, MD, MPH

Chronic rhinosinusitis (CRS) is a debilitating inflammatory disease generating ~$10-60B in direct costs/year in the U.S. Although maximal medical therapy (MMT) is recommended prior to surgery, it is associated with high rates of failure, and some estimates are that approximately 2% of patients progress to endoscopic sinus surgery (ESS) every year. However, following ESS approximately 50% of patients report uncontrolled CRS symptoms. ESS also has a 1% risk of serious and costly complications. New medical treatments are being developed that may reduce ESS eligibility and costs. Economic models can help estimate their economic implications.


A three-year cost-offset model was developed incorporating CRS-related parameters derived from the medical literature: prevalence, ESS progression rate, revisions, post-ESS complication rate, and post-ESS healthcare costs. Costs were adjusted to 2017 dollars. A probabilistic sensitivity analysis was conducted.


For every 1M adults, there are approximately 115,000 CRS patients, of whom 7,272±514 would be treated with ESS over 3 years. ESS, revisions, and complications would account for 73.5±3.4% of overall CRS costs. Each 10% reduction in the ESS rate would avoid a total of $9±2.0M ($1,219±11.23 per patient per year) in ESS-associated costs, including $7.5±1.6M in ESS, $1.0±0.23M in medications, $0.74±0.16M in office visits, and $0.53±0.12M in radiology and endoscopy costs. The model was most sensitive to changes in ESS cost, annual ESS rate, and CRS prevalence.


This cost-offset model suggests that MMT capable of reducing surgical eligibility has the potential to meaningfully reduce the cost of care of patients with CRS.