POSB143 The Financial Burden of Surgically Managing Chronic Rhinosinusitis with Nasal Polyposis in England

Abstract

Chronic rhinosinusitis with nasal polyposis (CRSwNP) characterised by type 2 inflammation imposes significant burden of illness. Many patients whose symptoms are uncontrolled by intranasal corticosteroids need repeated surgeries to alleviate rhinorrhea, nasal congestion, hyposmia and/or facial pressure. The objective of this study was to determine the financial burden due to surgically managed CRSwNP from an NHS perspective. Hospital Episode Statistics (HES) were used to capture the characteristics and costs for all CRSwNP patients with ≥1 sinus surgery in England between April 2010 and March 2020. Patients were stratified into subgroups based on the absence (NP-No Comorbidities (NC)) or presence of relevant comorbidities such as asthma only (NP-Asthma) or asthma with NSAID exacerbated respiratory disease, known as Samter’s triad (NP-ST). 101,054 patients were included in the study (64% (n=64,461) NP-NC, 31.7% (n=32,049) NP-Asthma, 4.5% (n=4,544) NP-ST). The total cost of treating these patients was £260 million, with surgery tariffs, inpatient tariffs and outpatient tariffs accounting for 66.8% (£173.8million), 11.3% (£29.3 million) and 21.9% (£57 million) respectively. The average surgery tariff for an NP-ST patient was £2,089, significantly higher than the tariff associated with the NP-Asthma (£1,755), and NP-NC (£1,676) subgroups (p<0.01). Both inpatient and outpatient average tariffs were numerically and statistically significantly higher for NP-ST and NP-Asthma patients compared to NP-NC patients. Combined inpatient and outpatient tariffs were £631 per NP-NC patient, rising to £1,103 and £2,253 for NP-Asthma and NP-ST patients respectively. Surgical management of CRSwNP constitutes a significant direct financial burden on the English healthcare system, particulary for patients with comorbidities. These patients, or those with a poor surgical prognosis, may benefit from the emerging novel biologic therapies which can reduce the clinical burden of disease. Such treatment strategies may also contribute to a reduction in the significant financial burden associated with surgical costs.