Healthcare Cost for Patients With Chronic Rhinosinusitis With Nasal Polyps and Comorbid Asthma

OBJECTIVES: Chronic rhinosinusitis with nasal polyps (CRSwNP) has high prevalence and disease burden. Traditionally, intranasal and systemic corticosteroids and endoscopic sinus surgery (ESS) are used as treatment. CRSwNP is commonly comorbid with asthma, however, there is lack of knowledge concerning the economic impact on the healthcare sector for this patient population.

METHODS: Electronic health records of patients diagnosed with CRSwNP between 1.1.2012-31.12.2018 in Finnish healthcare were included in the study. Data from 2000-2012 was used to assess comorbidities and clinical characteristics. The baseline period was set to 36 months prior to first CRSwNP diagnosis. Costs were reported for respiratory related causes and were derived separately for primary and secondary care contacts and procedures, and medication purchases. Costs were presented for different asthma groups depending on severity. The 95% CI for point estimates were evaluated by bootstrapping the costs.

RESULTS: A total of 18563 patients had a diagnosis of CRSwNP during the study period, with 27% having an asthma diagnosis, whereof 6% had severe asthma, and 1.5% had severe uncontrolled asthma. At baseline, the average per patient costs of CRSwNP patients was €742 (95% CI €724-€760). The corresponding point estimates at follow-up for different asthma groups (no asthma, mild to moderate asthma, severe controlled asthma, and severe uncontrolled asthma) were €1744 (€1710-€1779), €4449 (€4313-€4591), €7480 (€7120-€7856) and €12673 (€11393-€13998), respectively. For patients with severe comorbid asthma, 48% of the costs were medication purchases, 46% were secondary care, and 6% primary care. CRSwNP patients with comorbid asthma continued generating higher healthcare costs after the ESS, in contrast to patients without comorbid asthma.

CONCLUSIONS: CRSwNP patients with more severe asthma comorbidity generated higher economic burden on the healthcare sector compared to patients without comorbid asthma. ESS did not decrease the mean cumulative costs for CRSwNP patients with comorbid asthma.