Treatment burden and healthcare resource utilization in patients with chronic rhinosinusitis with nasal polyps who did or did not undergo functional endoscopic sinus surgery: a US real-world retrospective cohort study

Aim: To compare oral corticosteroid (OCS) burden and healthcare resource utilization (HCRU) in patients with chronic rhinosinusitis with nasal polyps undergoing functional endoscopic sinus surgery (FESS; intervention) versus not undergoing FESS. Materials & methods: Retrospective cohort study using US claims data (Optum’s de-identified Clinformatics^R○ Data Mart Database; 2011–2021). Groups were propensity score (PS) matched to adjust for confounding. OCS burden (cumulative dose in mg prednisone equivalents) and HCRU were assessed during baseline (365 days pre-index), intervention (days 0–44), and follow-up (days 45–365); costs during intervention and follow-up. Results: Before PS-matching, both groups had substantial comorbidity burden (>50% allergic rhinitis; >25% asthma) and over half of patients had used OCS (65% [FESS] vs 52% [non-FESS]; p < 0.01). After PS-matching (n = 8909 per group), OCS cumulative dose during follow-up was 18% lower among FESS versus non-FESS patients (mean difference:-40 mg per patient [95% CI:-57,-23; p < 0.01]). Similar proportions of patients filled OCS prescriptions during follow-up (35% [FESS], 36% [non-FESS]) and in these patients, OCS burden remained high (mean [SD] cumulative dose 521 [786] vs 612 [906] mg, respectively). Mean total healthcare costs per patient during the intervention period were $28,832 (FESS) and $2537 (non-FESS), but similar during follow-up ($15,659 and $15,926, respectively). HCRU was similar in follow-up, except more FESS patients visited an otolaryngologist (57% vs 32%, p < 0.01). Conclusion: In US clinical practice, OCS burden in patients with chronic rhinosinusitis with nasal polyps was significantly lower but remained substantial following FESS, and HCRU and costs during follow-up were similar to matched patients without FESS. Plain language summary What was the aim of this research? To compare the burden of medications, visits, procedures and costs between patients with chronic rhinosinusitis with nasal polyps who did nor did not undergo polyp removal surgery. How was the research carried out? Anonymized administrative health-claim data were analyzed through the year before and up to 3 years after surgery. To allow for a fair comparison between patients who did and did not have surgery, patients were matched according to a range of factors including age, gender, race and prior use of medications. What were the results? Between 45 and 365 days after surgery, patients had an 18% lower average cumulative dose of oral corticosteroids (OCS) compared with patients who did not have surgery. The proportion of patients with prescriptions for OCS was similar between the surgery and nonsurgery groups (35% and 36%, respectively). Similarly, there was little difference in the use of other medications. Otolaryngologist visits were more common for patients who had surgery than those who did not. Costs were similar after surgery between the surgery and no-surgery groups through 3 years of follow-up. What do the results of the study mean? This study found that OCS use was lower over the 3 years after sinus surgery but remained substantial for both the surgery and nonsurgery patient groups. Further, surgery only marginally reduced costs during the follow-up period. These results serve as evidence for policymakers and healthcare providers when deciding the most cost-effective way to treat patients with chronic rhinosinusitis with nasal polyps. Shareable abstract: In US clinical practice, oral corticosteroid use in patients with chronic rhinosinusitis with nasal polyps was significantly lower but remained substantial following endoscopic sinus surgery, and healthcare resource utilization and costs during follow-up were similar to matched patients without surgery.