PRS58 - Balloon Catheter Dilation For Chronic Rhinosinusitis Does Not Increase The Frequency Of Sinus Surgeries In The United States

Abstract

Balloon catheter dilation (BCD) of sinus ostia performed by surgeons to treat patients suffering from chronic rhinosinusitis (CRS) refractory to medical management has recently been shown to be safe and effective as an in-office procedure. This approach thus provides physicians with the opportunity to treat patients in a low-acuity care setting, whereas traditional endoscopic surgery is performed in the operating room. Recent publications have raised concerns about the potential for this technology to increase the number of patients surgically treated through supplier-induced or normal, patient-driven demand. This study was therefore conducted to evaluate the total volume of sinus surgeries (including BCD procedures) from 2006 to 2011, to determine whether the introduction of BCD in 2005 increased sinus surgery volumes in the United States. The Marketscan databases were queried from 2006 to 2011 using CPT codes associated with functional endoscopic sinus surgery (FESS: CPT 31254 - 31288) and BCD (CPT 31295 - 31297). Total surgery and procedures counts were analyzed separately, as each surgery could include one or multiple FESS or BCD procedures (ie, one or multiple sinuses treated per patient). A projection methodology developed by Marketscan was applied to estimate US-wide frequencies. Procedural case-mix and total average payment per surgical event were also analyzed for each year of interest. Total individual procedural volume growth reached an average compounded annual growth rate (CAGR) of 1.4% from 2006 to 2011. The number of surgeries, however, only grew by a CAGR of 0.9% during that timeframe, a rate comparable to that of the overall US population (0.8%). BCD did not result in significant growth of procedures or surgeries, thus suggesting that the criteria for selecting patients for surgery did not change with the introduction of BCD. The growth in procedures slightly outpaced that of surgeries, suggesting a potentially larger number of procedures per surgery.