OBJECTIVES: We sought to quantify the cost burden and healthcare utilization in chronic rhinosinusitis (CRS) patients, with and without nasal polyposis (CRSwNP and CRSsNP), who require treatment with endoscopic sinus surgery (ESS). The additive contributions of nasal polyposis (NP) and revision surgery to 1-year costs were also evaluated.

METHODS: Data from 2012-2015 were extracted from the Blue Health Intelligence database. Adult patients (age 18-64) having ESS (ethmoidectomy CPT 31254 or 31255) for CRS, with index visits of <1 week and medical and pharmacy enrollment for ≥1 year pre- and post- index surgery were included. Related healthcare utilization was defined as any visit with a primary diagnosis of CRS, acute sinusitis, or NP, or any prescription from a therapeutic category commonly used to treat CRS or related comorbidities. The primary outcomes included one-year revision rates and one-year medical and pharmacy expenditures.

RESULTS: A total of 23,542 patients met all inclusion criteria (mean age 44; 50% male), and 9,665 (41.1%) also had NP. The revision ESS rate within 1 year was 2.1%, and these occurred twice as often in CRSwNP compared to CRSsNP (3.1% vs. 1.4%). Mean one-year cost of treatment, including the index ESS, was $8,668 for CRSsNP and $10,757 for CRSwNP in patients not requiring revision ESS. For those requiring revision ESS within the first year, mean one-year expenditures increased by $11,186 to $19,853 for CRSsNP and by $13,395 to $24,153 for CRSwNP.

CONCLUSIONS: In a large commercially insured US population, the disease-related expenditures for patients having ESS for CRS are substantial, as are the additive impacts of NP and revision surgery. CRSwNP doubled the risk of revision surgery in the first year after ESS compared to CRSsNP and cost 24% more, even in the absence of a second procedure.