Upfront computed tomography scanning is more cost-beneficial than empiric medical therapy in the initial management of chronic rhinosinusitis

Randy Leung*, Robert C Kern, Neil Jordan, Stella Almassian, David B Conley Jr, Bruce Kuang-Huay Tan, Rakesh Chandra

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

25 Scopus citations

Abstract

Background: Current treatment algorithms for patients with symptoms of chronic rhinosinusitis (CRS) recommend a trial of empiric medical therapy prior to obtaining a sinus computed tomography (CT) scan, even in cases of negative nasal endoscopy. This empiric approach evolved in an era when same day conventional CT was both impractical and economically irresponsible. The objective of this work was to determine whether upfront CT scanning is more cost-beneficial than empiric medical therapy for patients presenting with CRS symptoms but negative endoscopic findings. Methods: A Markov economic model was employed. Medication costs, CT costs, treatment response rates, and treatment associated adverse event rates were included as model parameters. Treatment cost values were derived from Medicare. Results: There is a clear cost advantage to the upfront CT algorithm over empiric therapy regardless of the availability of point-of-care CT scanning (POC-CT). This advantage persists during the sensitivity analysis when costs and response rates are fully biased toward empiric therapy. If POC-CT is available, upfront CT can save $320.50 per patient (range, $138.5-671.5). When POC-CT CT is unavailable, upfront CT savings persist at $296.60 (range, $106.09-655.40). Conclusion: In patients meeting symptom criteria for CRS but without endoscopic evidence of inflammation, upfront CT scanning is more cost-beneficial than empiric medical therapy. Adopting upfront CT scanning can save the U.S. healthcare system $1.2 billion dollars per year. Further, POC-CT can offer same day diagnosis, facilitate prompt treatment, and decrease unnecessary antibiotic prescriptions.

Original languageEnglish (US)
Pages (from-to)471-480
Number of pages10
JournalInternational Forum of Allergy and Rhinology
Volume1
Issue number6
DOIs
StatePublished - Nov 1 2011

Keywords

  • CT scan
  • Chronic rhinosinusitis
  • Empiric medical therapy
  • Health economics
  • Markov model

ASJC Scopus subject areas

  • Immunology and Allergy
  • Otorhinolaryngology

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