Frequency of endoscopic sinus surgery and healthcare costs in relation to comorbid asthma in subjects with CRSwNP

Sanna Toppila-Salmi (Helsinki, Finland), Jenni Hällfors (Espoo, Finland), Juhani Aakko (Espoo, Finland), Bettina Mannerström (Espoo, Finland), Kaisa Nieminen (Espoo, Finland), Gunilla Telg (Stockholm, Sweden), Lauri Lehtimäki (Tampere, Finland)

Background

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a phenotype of CRS with a high tendency of eosinophilia, persistent inflammation and symptoms, where asthma is a common comorbidity. Treatment of CRSwNP includes intranasal corticosteroids and short courses of systemic corticosteroids, but for patients who are non-responsive to corticosteroid treatment, endoscopic sinus surgery (ESS) may be considered. This observational study aimed to describe the frequency of ESS and healthcare costs and their relation to comorbid asthma in Finnish CRSwNP patients.

Method

Electronic health records of patients diagnosed with CRSwNP (ICD-10 diagnosis codes: J32.4 or J33.0, J33.1, J33.8, J33.9, or a polypectomy of internal nose (DHB20)) between 1.1.2012-31.12.2019 in Finnish specialty and primary care were included in the study. The patients were divided into subgroups based on the presence, severity and control of asthma: no asthma, mild-moderate asthma, severe asthma, and severe uncontrolled asthma. A mean cumulative count of ESS was calculated over time per subgroup. The costs for healthcare resource use were calculated one year before and after the first ESS.

Results

In total, 18 563 patients (59.9% male) had a first record of CRSwNP during the study period, 27% had a diagnosis of asthma (including severe asthma), whereof 6% of the patients had severe asthma, and 1.5% had severe uncontrolled asthma. Overall, 47% had undergone at least one ESS after one year of follow-up. Both having asthma and asthma severity had an impact on the mean cumulative count of ESS. CRSwNP patients without asthma had undergone on average 0.5 ESS, while patients with severe asthma had undergone 0.7 ESS, and severe uncontrolled asthma patients 0.8 ESS three years post diagnosis. After ESS, severe asthma comorbidity continued to generate more costs compared to patients without asthma or with non-severe asthma (Figure 1). Secondary care contacts and medication purchases accounted for most of the respiratory related costs.

Conclusion

Health care costs were higher in patients with comorbid asthma than for patients without asthma. Costs were increasing in line with asthma severity, also after ESS, especially in CRSwNP patients with severe and severe uncontrolled asthma.