Abstract
ObjectivesTo provide insight into healthcare utilisation of rhinosinusitis, compare data with clinical practice guideline recommendations and assess practice variation.DesignAnonymised data from claims reimbursement registries of healthcare insurers were analysed, from 1 January 2016 until 31 December 2016.SettingSecondary and tertiary care in the Netherlands.ParticipantsPatients ≥18 years with diagnostic code “sinusitis.”Main outcome measuresHealthcare utilisation (prevalence, co‐morbidity, diagnostic testing, surgery), costs, comparison with guideline recommendation, practice variation.ResultsWe identified 56 825 patients, prevalence was 0.4%. Costs were € 45 979 554—that is 0.2% of total hospital‐related care costs (€21 831.3 × 106). Most patients were <75 years, with a slight female preponderance. 29% had comorbidities (usually COPD/asthma). 9% underwent skin prick testing, 61% nasal endoscopy, 2% X‐ray and 51% CT. Surgery rate was 16%, mostly in daycare. Nearly, all surgical procedures were performed endonasally and concerned the maxillary and/or ethmoid sinus. Seven recommendations (25%) could be (partially) compared to the distribution of claims data. Except for endoscopy, healthcare utilisation patterns were in line with guideline recommendations. We compared results for three geographical regions and found generally corresponding rates of diagnostic testing and surgery.ConclusionPrevalence was lower than reported previously. Within the boundaries of guideline recommendations, we encountered acceptable variation in healthcare utilisation in Dutch hospitals. Health reimbursement claims data can provide insight into healthcare utilisation, but they do not allow evaluation of the quality and outcomes of care, and therefore, results should be interpreted with caution.
Highlights
Rhinosinusitis is defined as symptomatic inflammation of the nasal cavity and paranasal sinuses
Healthcare reimbursement claims data have been used to assess non-adherence to guideline recommendations; we will compare our data to Dutch recommendations from the CBO 20120 guideline on chronic rhinosinusitis (CRS) to detect potential deviations from protocol.[7,10]
Nasal endoscopy is registered by Dutch otolaryngologists themselves which might lead to under-registration due to limited time and lack of financial incentive
Summary
Rhinosinusitis is defined as symptomatic inflammation of the nasal cavity and paranasal sinuses. Patients with a prolonged or complicated course (eg meningitis, brain abscess, orbital cellulitis and orbital abscess) can be distinguished.[1,2] Two or more symptoms should be present, one of which should be either rhinorrhea in ARS and RARS (anterior/posterior or both) or nasal blockage in CRS. For ARS and RARS, the diagnosis is confirmed by symptoms, for CRS by signs of inflammation at anterior/posterior rhinoscopy and/or pathological findings on CT.[1,2] There is a distinction between CRS with nasal polyps and without nasal polyps.[1,2] Worldwide, RS is a common disease, with a reported incidence of around 12%.1. Healthcare reimbursement claims data have been used to assess non-adherence to guideline recommendations; we will compare our data to Dutch recommendations from the CBO 20120 guideline on CRS to detect potential deviations from protocol.[7,10]
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