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Original Investigation |

Effect of Continued Medical Therapy on Productivity Costs for Refractory Chronic Rhinosinusitis

Luke Rudmik, MD, MSc1; Zachary M. Soler, MD, MSc2; Timothy L. Smith, MD, MPH3; Jess C. Mace, MPH3; Rodney J. Schlosser, MD2; Adam S. DeConde, MD4
[+] Author Affiliations
1Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada
2Division of Rhinology and Sinus Surgery, Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston
3Division of Rhinology and Sinus Surgery, Oregon Sinus Center, Department of Otolaryngology–Head and Neck Surgery, Oregon Health and Science University, Portland
4Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, University of California, San Diego
JAMA Otolaryngol Head Neck Surg. 2015;141(11):969-973. doi:10.1001/jamaoto.2015.2321.
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Importance  It is estimated that lost productivity related to chronic rhinosinusitis (CRS) costs society in excess of $13 billion per year in the United States. Given this tremendous cost to society, it is important to evaluate the effect of current interventions on improving this productivity loss.

Objective  To define the change in productivity costs in patients with refractory CRS who select continued medical therapy.

Design, Setting, and Participants  Observational cohort study. Thirty-eight patients with a guideline-based diagnosis of CRS whose initial appropriate medical therapy failed were enrolled from 4 tertiary-level rhinology clinics. The study was conducted from December 6, 2010, to April 23, 2013, and data analysis was performed from December 6, 2010, to June 1, 2015.

Interventions  Continued medical therapy for CRS.

Main Outcomes and Measures  The human capital approach was applied to quantify productivity costs. Absenteeism, presenteeism, and lost leisure time were quantified to define annual lost productive time, which was measured at enrollment (baseline) and at a minimum of 6 months after treatment. Lost productive time was monetized using the annual daily wage rates obtained from the 2012 US National Census and the 2013 US Department of Labor statistics.

Results  Thirty-eight patients with refractory CRS who selected continued medical therapy had a mean (SD) baseline annual productivity cost of $3464 ($4900) per patient. After continued medical therapy for a mean of 12.8 (4.8) months, productivity costs were $2730 ($3720) (before vs after continued medical therapy productivity cost, P = .74). Mean annual absenteeism was reduced from 5 (12) days to 2 (8) days (P = .02). Mean annual presenteeism (17 [27] days reduced to 15 [23] days; P = .93) and mean annual household days lost (7 [7] days reduced to 6 [6] days; P = .51) were maintained at baseline levels. There were no significant differences in productivity outcomes based on endoscopy, the 22-item Sinonasal Outcome Test score, age, or polyp status (all P ≥ .11).

Conclusions and Relevance  Patients with refractory CRS often make treatment decisions based on the degree of quality-of-life and productivity impairment. Outcomes from this study suggest that productivity in patients with refractory CRS who have minor reductions in baseline productivity can remain stable with continued medical therapy. Physicians can use this information to inform appropriate patients with CRS of their expected outcomes from continued medical therapy.

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