Recurrent acute rhinosinusitis: epidemiology and health care cost burden.
OBJECTIVE
To determine the epidemiology of recurrent acute rhinosinusitis (RARS) and to understand direct health care costs attributable to RARS as a potentially underdiagnosed form of chronic rhinosinusitis.


METHODS
Retrospective longitudinal analysis of a medical claims database.


METHODS
Academic medical center.


METHODS
Medical claims data (2003-2008) from a large payer database were analyzed. Adult patients with RARS (defined as at least 4 acute rhinosinusitis claims each with a filled oral antibiotic prescription in a 12-month period) were extracted. Sinonasal diagnostic procedures, provider visits, and medical costs were determined.


RESULTS
A total of 4588 patients were identified (mean age, 43.5 years; 72.1% female) among 13.1 million patients, for a point prevalence of 0.035%, which remained consistent across years. After 1, 2, and 4 years, 2.4%, 5.4%, and 9.2% of patients subsequently received nasal endoscopy and 11.4%, 23.5%, and 39.9% received paranasal sinus computed tomography, respectively. RARS patients averaged 3.8 antibiotic prescriptions, 5.6 other sinus-related prescriptions, and 5.6 provider visits per year. Total direct health care costs related to RARS averaged $1091/patient-year, with oral antibiotic and nasal prescription costs averaging $210 and $452 per year, respectively.


CONCLUSIONS
RARS may affect approximately 1 in 3000 adults per year. Despite significant direct health care costs of more than $1000/year per individual patient with RARS, nasal endoscopy and computed tomography are not commonly obtained early after potential diagnosis. RARS is likely an underdiagnosed condition warranting further study.
Division of Otolaryngology, Brigham and Women's Hospital, and the Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA.
Neil
N
Bhattacharyya
Jeff
J
Grebner
Noel G
NG
Martinson
D000208:Acute Disease; D000328:Adult; D017281:Cost of Illness; D004724:Endoscopy; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D012008:Recurrence; D012189:Retrospective Studies; D012220:Rhinitis / Q000150:complications / Q000191:economics* / Q000453:epidemiology* / Q000628:therapy; D012852:Sinusitis / Q000150:complications / Q000191:economics* / Q000453:epidemiology* / Q000628:therapy