- There was an individual direct cost of $770 to $1,220 per patient-year for CRS.
- RS-related work productivity cost approaches $4 billion annually in the United States.
- According to quality-of-life studies examined for the statement, overall CRS quality of life is worse than that of patients with congestive heart failure, chronic obstructive pulmonary disorder, and Parkinson’s disease.
Review of potential pathophysiologic mechanisms and recommendations for diagnosis and treatment for RS. Focus is placed on the appropriate medical therapy at the minimum effective treatment level needed by patients. Contributing factors included anatomic variants, allergy, septal deviation, viruses, bacterial infection, biofilm, osteitis, reflux, vitamin deficiency, fungus, superantigens, innate immunity, microbiome and epithelial barrier disturbance, ciliary derangements, immunodeficiency, and aspirin-exacerbated respiratory disease. Each treatment recommendation is evaluated by aggregate level of evidence, benefit, harm, cost, benefits-harm assessment, value judgments, policy level, and intervention.
One interesting finding was a lack of evidence showing that antibiotics are effective as a standard treatment for all forms of CRS; instead of focusing on bacterial causes, the focus in treatment recommendations is placed more on limiting inflammation. “For CRS (but not ARS), it isn’t usually an infection as much as it is inflammation, although bacteria initiating or perpetuating the condition is possible and should be considered,” said Dr. Orlandi. “This differs from traditional clinical thought—a bacterial cause has been so dogmatic that many insurance companies will not approve surgery without the patient undergoing a round of antibiotics first. Hopefully, we can cut down on antibiotic overuse, as the evidence isn’t there to support its use in many CRS cases.”