OBJECTIVES : To analyze the absorption of economic resources related to the diagnostic, surgical and therapeutic pathway of chronic rhinosinusitis with nasal polyposis patients (CRSwNP), assuming the hospital perspective and stratifying for different patients’ characteristics.

METHODS : Real world data concerning CRSwNP pathway procedures and related costs were collected through the management control’ analytical accounting flows, gathered in public and private Italian hospitals. The micro-costing approach was used to quantify diagnostic services, drugs assumption, consumables; hospitalization costs, overhead costs, management of comorbidities and adverse events due to surgery were evaluated. Time-driven Activity-Based Costing (TDABC) was adopted for human resources and equipment costs allocation, in terms of amortization and use. Costs concerning activities were determined distinguishing 4 categories of patient’s ineligible for surgery; having 1 intervention; having more than 1 intervention; those who continue to receive corticosteroid treatments, considering a 24-month timeframe.

RESULTS : The average costs absorption showed that patients ineligible to surgery are associated to a cost of 1,702.51€. Similar results were attributed to patients who continue corticosteroid treatments (1,690.30€). The analysis determined that the highest costs were related to surgery: patients who underwent only 1 intervention were associated to a cost of 4,166.75€, value that increases to 7,009.67€ for those who show a disease resurgence and need more than 1 intervention (on average, 2.17 surgeries).

CONCLUSIONS : TDABC and the micro-costing approaches were useful tools to determine the costs of CRSwNP patients’ pathways, starting from RWD. Results show the importance of these information for decision makers, both for review internal hospital procedures, also in relation with the reimbursement tariffs, to achieve a higher level of efficiency, and to link costs data with well-being or outcome measures.

Further investigations should explore the impact of innovative biologic therapies. This could provide an in-depth analysis on the factors influencing the clinical choice.