Quantifying corticosteroid burden in chronic rhinosinusitis with nasal polyps

Background

Real-world burden data on systemic corticosteroid (SCS) use in chronic rhinosinusitis with nasal polyps (CRSwNP) are limited.

Objective

To describe the real-world burden of SCS in CRSwNP.

Methods

This retrospective cohort study included commercial/Medicare Advantage with Part D health plan members from the Optum Research Database with a first medical claim (index) for CRSwNP (January 2015-July 2020). Primary outcomes/variables included SCS use, health care resource utilization, and costs during the 12-month follow-up period. Outcomes were analyzed overall (N = 21,172) and stratified by baseline comorbid asthma status and sinus surgeries during follow-up.

Results

Overall, 64.7% and 41.0% of patients used all-cause and CRSwNP-related SCS, respectively, and 36.0% had ≥1 oral corticosteroid (OCS) burst (≥20 mg for 3-28 days); SCS use was higher in patients with asthma and those with a NP-related surgery (1, 2, and ≥3) vs without. The mean (SD) all-cause cumulative oral corticosteroid dose was 303.3 (675.0) mg/year and 23.5% had a cumulative annual dose ≥400 mg; these values were higher (P < .001) in patients with vs without comorbid asthma (514.9 [956.1] vs 247.5 [567.0]; 36.9% vs 19.9%). All-cause and CRSwNP health care resource utilization and costs increased with increasing number of surgeries; mean (SD) all-cause total medical costs were $14,472 (38,915), $26,909 (40,800), $29,816 (41,677), and $31,558 (37,143) with 0, 1, 2, and ≥3 surgeries, respectively.

Conclusion

These data highlight the significant burden of SCS use in CRSwNP, particularly in patients with comorbid asthma, and suggest a need to reduce SCS exposure.