His preferred use, he said, is to place them in the outpatient clinic at the time of the first post-operative cleaning. Unlike in many hospitals and surgery centers that reimburse for these implants, however, getting reimbursement in clinics can be difficult, and for these patients he advocates for reimbursement on a case-by-case basis.
Explore This IssueMarch 2014
Reimbursement, according to Dr. Kennedy, is the primary limitation to the wider use of these implants because of the ongoing difficulty of getting a separate CPT code to warrant adding the costs of these implants to the already established cost of the procedure. Currently, the implants cost about $600 each.
Dr. Kern, one of the clinicians who works in a setting in which the implants are reimbursed, has placed more than 200 of these devices over the past couple of years. “Rhinosinusitis is primarily a local disease associated with the nose and respiratory tract, so it makes sense to deliver drugs locally to address the problem,” he said.
Like Dr. Kennedy, he thinks the implants work best in patients with nasal polyps. He also thinks the implants are well suited for those with an unstable middle turbinate.
In addition to the benefits to individual patients, including the reduction of side effects associated with systemic steroids, Dr. Kern emphasized the benefit to society as a whole. “The No. 1 diagnosis associated with an adult outpatient antibiotic prescription is rhinosinusitis,” he said, adding that 11% of all outpatient adult antibiotic prescriptions are associated with either acute or chronic rhinosinusitis. In addition to only modest efficacy and substantial cost, antibiotic overuse is a major contributor to the development of resistant microbial strains. “So there is a really a compelling societal issue,” he said. “Rhinosinusitis is such a common problem, and we need other tools in our tool chest to manage the problem.”
He hopes that this is the first of a number of products that will provide not only steroids, but also perhaps antibiotics or other drugs locally, depending on the type of sinus problem. “There are devices under development right now that are similar to this implant, and hopefully they can be used one day in the office setting,” he said.
The need for these implants in the office setting is highlighted by Michael Sillers, MD, founder and director of the Alabama Nasal and Sinus Center at St. Vincent’s Health and Wellness in Birmingham, Ala., who emphasized that most of the procedures to correct symptoms of rhinosinusitis are performed in an outpatient, ambulatory surgery setting like the center in which he works. He has only placed three of these implants so far, however, because of the prohibitive cost.