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.