Abstract
Objectives: Chronic rhinosinusitis (CRS) is a common and costly health problem in the United States. While often associated with younger adults, CRS can affect the elderly. As the aging population increases in the United States, the cost burden of CRS in older adults is important to assess. The objective of this study is to characterize healthcare resource utilization (HCRU) and healthcare expenditure (HCE) for CRS in this population. Methods: Patients meeting criteria for CRS with three years of continuous data were identified on IBM® Marketscan Research Databases over a five-year period (2013–2017). Medication utilization, outpatient visits, surgery, and expenditures related to CRS were assessed for older adults (>65) and compared with other age groups. As a secondary analysis, multivariable generalized linear models were utilized to compare HCE while adjusting for baseline medication utilization. Results: A total of 238,825 patients met the inclusion criteria, of which 20,927 were older adults. Older adults had the highest overall prevalence of nasal polyps (10%) and asthma (16%) among adult groups. Surgery rate was lower than other adult groups, but medication utilization was the highest. Mean overall HCE at two years was highest in older adults (USD 2545 vs. 2298 in young adults). However, HCE was highest for the young adult group after adjusting for baseline medication usage. Conclusion: Older adults had a higher rate of CRS-related co-morbidities as well as the highest CRS-related medication utilization and unadjusted two-year HCE. Although the reasons for this are unclear, possibilities include greater disease severity and preference for medical versus surgical management. HCE for CRS is expected to increase as the aging population grows.
Highlights
Chronic rhinosinusitis (CRS) is one of the most common chronic conditions in the United States, with an estimated prevalence of 15% and annual direct costs of up to USD 9.9 billion dollars [1]
Due to the high economic burden of CRS, a closer examination into resource utilization for CRS is warranted. This would be critical in developing new strategies for cost reduction, quality improvement, and appropriate allocation of resources, especially as it pertains to government healthcare spending
Using the young adult group as the reference, the two-year healthcare expenditure (HCE) was 24.9% lower in the pediatric group, 2.8% lower in the middle-aged group, and 10.5% lower in the older adult group
Summary
Chronic rhinosinusitis (CRS) is one of the most common chronic conditions in the United States, with an estimated prevalence of 15% and annual direct costs of up to USD 9.9 billion dollars [1]. Not life-threatening, CRS can have a significant impact on quality of life, with persistent symptoms and recurrent exacerbations despite medications and surgery. Due to the high economic burden of CRS, a closer examination into resource utilization for CRS is warranted. This would be critical in developing new strategies for cost reduction, quality improvement, and appropriate allocation of resources, especially as it pertains to government healthcare spending. Others have demonstrated less improvement in quality of life scores after sinus surgery [5] as well as higher antibiotic utilization in older adults [6]. It is likely that older adults are less likely to undergo surgery due to co-morbidities, and may need to tolerate prolonged periods with higher symptom burden
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