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20426984, 2021, 3, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/alr.22741 by Stanford University, Wiley Online Library on [01/07/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License

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Orlandi et al.

Acute Bacterial Rhinosinusitis (ABRS) Direct cost estimates attributable to the diagnosis and treatment of ABRS are sparse in the literature. The disease burden of ABRS has been primarily assessed using utiliza tion measures such as office visits and antibiotic prescrip tion rates. For example, there are approximately 5.1 mil lion ambulatory office visits per year with a coded diagno sis of ARS and approximately 86% of these visits result in an oral antibiotic prescription. 226 ABRS is the fifth most com mon diagnosis associated with antibiotic therapy. 88 Data regarding the direct costs of ABRS are limited, although studies from Europe suggest direct costs of ABRS of €97 to €266 (approximately USD$115-USD$315) per episode , depending on treatment model and antibiotic resistance rates. 227,228 Chronic Rhinosinusitis (CRS) Analyses of the direct costs of CRS may include the costs for both recurrent acute rhinosinusitis (RARS) and the traditional form of CRS. The direct costs of CRS have been ascertained on multiple levels based on single institutional cohorts, analyses of claims databases and analyses of nationally representative healthcare cost data sets. For example, individual patient cohorts, most com monly from academic medical centers, have quantified the direct medical costs at USD$921-1220 per patient year. 229,230 These data may, however, may represent a bias toward more diseased patient populations and also rely on some extrapolation of costs. More recent claims-based studies have provided more refined and generalized cost data for CRS. In a study of 4.4 million patients, Bhattacharyya et. al. identified 4460 patients undergoing ESS. 89 The healthcare costs for CRS in the year leading up to ESS (therefore, medically refrac tory patients) were USD$2449, USD$1789 of which were attributable to facility and physicians’ charges. Finally, a population-based assessment has determined incremen tal costs of CRS relative to those without CRS. Bhat tacharyya determined significantly increased incremental healthcare utilization costs of USD$772, USD$346, and USD$397 for total healthcare expenses, office-based expen ditures, and prescription expenditures ( p ≤ 0.01 vs those adults without CRS) for CRS in a nationally representative healthcare economics database. 90 A similar population based assessment suggested that these incremental costs may be rising to as much as USD$1152 per afflicted indi vidual annually. 231 From an international perspective, also utilizing a national healthcare insurance database, Chung et al., found that patients with CRS diagnoses incurred significantly higher outpatient costs (USD$953 vs USD$665; p < 0.001) and total healthcare costs (USD$1318 vs USD$946; p < 0.001). 91 Examining CRSwNP specifi cally, Bhattacharyya et al. found an incremental increase

in annual direct medical costs of USD$1067 per patient vs controls without CRS. 92 Although less commonly studied, recent claims-based data indicate an annual direct cost of treatment attributable to RARS of USD$1091 per patient year. 232 With the increasing availability of over-the-counter and adjunctive remedies for the management of CRS, the patient’s out-of-pocket expenses is significant. For exam ple, Yip et al. derived a yearly out-of-pocket expense in a Canadian cohort of patients of approximately USD$614 per year. 233 The current overall direct cost burden of CRS in the United States has been estimated at USD$10-13 billion per year. 234 Surgical Costs in CRS In CRS cases found to be medically refractory, endoscopic sinus surgery (ESS) has proven to be a clinically and eco nomically effective management option, but the overall costs of ESS do warrant consideration. 235,236 In a system atic review, Smith et al. reviewed 10 studies specific to ESS and found that the cost of outpatient ESS ranges from $8200 to $10,500 per procedure in 2014 USD. In a large claims-based study, Purcell et al. found that although the mean surgical cost of ESS was USD$7,782, direct health care costs decreased steadily in the 3 years after surgery with greater than half of the patients resolving direct costs attributable to CRS. 93 Cost for ESS may vary widely and the component extent of surgery (eg, anterior ESS vs full ESS) as well as the geographic location of the procedure influence this. 237 Finally, costs of ESS will also vary based on international geography and healthcare system. For example, Au and Rudmik found that the overall cost for routine outpatient ESS approximated $3510 in Canadian dollars from the perspective of the Canadian government payer. 238 VI.A.2 Indirect Costs of Rhinosinusitis The indirect healthcare costs of RS include societal costs related to absence from work (absenteeism), decreased work productivity while at work (presenteeism) and other forms of lost productivity (eg, leisure time lost). Such costs can be measured in terms of time, such as workdays lost, or in terms of dollar equivalents based on prevailing wages. In a nationally based household study, among the 15.2% of those reporting acute or chronic RS annually, 5.7 workdays were missed vs 3.7 for those without RS ( p < 0.001). 87 This translates into 61.2 million potential workdays missed per year among adults in the United States and an estimated work productivity loss of USD$3.79 billion per year. 87,94 Data for presenteeism and other forms of lost productiv ity due to RS as a whole are sparse, but data for several subtypes of RS are available.