Severe radiographic disease in patients with chronic rhinosinusitis (CRS) was associated with incidence of nasal polyps and fewer antibiotic courses, but no significant difference was found regarding health care utilization vs those with low Lund-Mackay scores (LMS). Findings were reported in Laryngoscope Investigative Otolaryngology.
Affecting approximately 12% of the US population, CRS has been linked with increased health care utilization and indirect costs that exceed $20 billion annually. Prior research has indicated that LMS, the most widely applied CT staging system of sinonasal inflammatory changes, may be leveraged to identify prognostic features in the disease course of patients with CRS with nasal polyps, including blood eosinophil counts and risk of relapse after endoscopic sinus surgery.
“LMS measures radiographic disease severity for patients with CRS using CT images and is a validated scoring system used widely in research and clinical practice with high interobserver reliability,” said the study authors. “Although LMS provides valuable objective data, the scale poorly correlates with subjective patient-reported symptom scores at time of presentation.”
They sought to investigate the relationship between CRS radiographic disease severity measured by LMS and health care utilization. A prospective cohort of patients with CRS enrolled in a clinical registry was evaluated with regard to antibiotic courses, steroid courses, over-the-counter (OTC) pill use, health care provider visits, work or school days missed, and symptom duration.
“Nasal endoscopy findings and LMS were recorded for patients with sinus CT imaging. Patient symptom scores, demographic characteristics, and health care utilization measures were collected," the authors noted.
A total of 556 patients met inclusion criteria (mean age, 45.3 years; 53.4% male; 41.7% had nasal polyps), in which LMS was shown to be high (≥ 8) in 410 patients and low (< 8) in 146 patients. No differences in sex, smoking history, 22-item Sino-nasal Outcome Test scores, or past medical history were observed between the 2 LMS groups.
Compared with patients with CRS and low LMS, those with high LMS were more likely to undergo ESS (55.5% vs 73.7%; P < .01) and report incidence of nasal polyps (20.5% vs 49.3%; P < .01).
Further findings of a multivariable logistic regression analysis showed that patients with CRS who had high LMS used fewer antibiotic courses (odd ratio [OR], 0.68; 95% CI, 0.51-0.91), but were more likely to be managed with ESS (OR, 2.28; 95% CI, 1.41-3.73) and have nasal polyps (OR, 2.11; 95% CI, 1.16-3.93) compared with patients with low LMS.
No significant differences were observed between the 2 LMS groups for the number of steroid courses, OTC pill use, provider visits, work/school days missed, or symptom duration.
“To our knowledge, this is the first study examining the relationship between CRS radiographic severity and health care consumption measures,” concluded the study authors. “Although CRS patients may objectively have a more severe phenotype of CRS, they do not appear to utilize more medications or provider visits.”
Mehta MP, Hur K, Price CPE, et al. Radiographic disease severity in chronic rhinosinusitis patients and health care utilization. Laryngoscope Investig Otolaryngol. 2021;6(5):924-931. doi:10.1002/lio2.663