title: The impact of endoscopic sinus surgery on total direct healthcare costs among patients with chronic rhinosinusitis.
abstract: BACKGROUND
  This study investigates how endoscopic sinus surgery (ESS) impacts total direct healthcare costs, medication usage, and frequency of imaging among patients with chronic rhinosinusitis (CRS).
  
  
  METHODS
  Data were obtained from the MarketScan® Commercial Claims and Encounters databases (Truven Health Analytics); patients who underwent ESS for CRS in 2008 were identified. Healthcare costs, days of antibiotic and oral steroid usage, and number of computed tomography (CT) and magnetic resonance imaging (MRI) studies were collected for 12 months prior to and 36 months after surgery and compared in 1-year intervals.
  
  
  RESULTS
  A total of 8963 surgical patients were included. Median total direct costs fell from $4750 at preoperative baseline (95% confidence interval [CI], $4661 to $4838) to $4212 by year 3 after surgery (95% CI, $4078 to $4346). Disease-specific costs related to conditions commonly associated with CRS-asthma, allergy, depression, and headache-all decreased in the years after surgery; the reduction was significant for all conditions but asthma. Mean days of antibiotic usage per year decreased from 28.2 days before surgery to 15.9 days by year 3 after surgery, p value <0.001. Days of oral corticosteroid usage remained stable at just over 7 days. Mean number of imaging studies fell from an average of 1.6 in the year before surgery to 0.2 by year 3 after surgery, p value <0.001.
  
  
  CONCLUSIONS
  Among patients who underwent ESS for CRS, total direct healthcare costs, antibiotic usage, and number of imaging studies decreased after surgery, and remained below preoperative levels throughout all 3 years of follow-up. Oral corticosteroid usage remained stable.
authors: Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, WA.
authors: Patricia L
authors: PL
authors: Purcell
authors: Department of Surgery, University of Washington, Seattle, WA.
authors: Sara
authors: S
authors: Beck
authors: Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, WA.
authors: Greg E
authors: GE
authors: Davis
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000191:economics / Q000627:therapeutic use; D002908:Chronic Disease; D004180:Direct Service Costs; D004724:Endoscopy / Q000191:economics*; D005260:Female; D005938:Glucocorticoids / Q000191:economics / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D012220:Rhinitis / Q000000981:diagnostic imaging / Q000191:economics* / Q000628:therapy; D012852:Sinusitis / Q000000981:diagnostic imaging / Q000191:economics* / Q000628:therapy; D014057:Tomography, X-Ray Computed / Q000191:economics
chemical_list: D000900:Anti-Bacterial Agents; D005938:Glucocorticoids
keywords: antibiotics; computed tomography; endoscopic surgical procedure; health services; sinusitis