Dr. Denneny’s work confirms the previously described “value proposition” that compared surgical management of chronic rhinosinusitis (CRS) to medical management. And it does so with the most comprehensive data dive yet, culling figures and metrics from 160 million patient years reported to Medicare and Truven Health MarketScan.
Explore This IssueJune 2018
“The main picture would be that it’s a broad-based disease affecting all groups, all sexes, all regions of the country,” Dr. Denneny said. “And there is an established medical paradigm for managing it and diagnosing it that works. When (patients) fail that, then the surgical procedures —endoscopic sinus surgery, and we’ve got some early balloon data—are beneficial both from a patient outcomes perspective and from a cost perspective.”
Having empiric figures also helps otolaryngologists when they talk with some insurance companies, Dr. Denneny said. Otolaryngologists can now report that the mean yearly cost of CRS was $958 in the commercial insurance population and $741 in the Medicare population, and they can point out that comorbidities exited in 56.9% of patients with CRS (led by allergic rhinitis, headache, and asthma).
The data is even more helpful when it comes to confirming the appropriate use of debridement and nasal endoscopy by otolaryngologists. “We’re told by the insurance companies that people are debriding eight or 10 times,” he added. “The average is 1.78, and that’s for an entire post-op period of seven-and-a-half months of healing, which is a generous amount of time. That is extremely powerful, and the same with nasal endoscopy, which is only 1.76.”
Otolaryngologists are “reasonably treating” these cases, Dr. Denneny said. “They’re not doing procedures that aren’t necessary on these patients. And that’s a big message to the public.”
Richard Quinn is a freelance medical writer based in New Jersey.