When do the risks of repeated courses of corticosteroids exceed the risks of surgery?

Randy M. Leung, Keith Dinnie, Timothy Smith

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Background: The management of chronic rhinosinusitis with nasal polyposis (CRSwNP) becomes unclear when patients require multiple courses of corticosteroids to maintain quality of life. Repeated courses of corticosteroids carry increased risks to patients. Although endoscopic sinus surgery (ESS) is an effective therapeutic modality, it also carries inherent risks. This study aims to identify the threshold at which the risks of repeated courses of corticosteroid exceed the risks of surgery. Methods: An evidence-based risk analysis was simulated using literature-reported complication rates, quality of life changes, and Medicare costs. Simulations were performed from the Medicare patient perspective, societal perspective, and the universal healthcare patient perspective. Results: All 3 simulations demonstrate a breakeven threshold favoring surgery over medical therapy when patients require oral corticosteroids (OCS) more often than once every 2 years in CRSwNP, once per year in CRSwNP/asthma, or twice per year for Samter's triad patients. Conclusion: This represents the first rationalized evidence-based analysis for when surgery should be considered in place of repeated courses of oral corticosteroids. This threshold provides a guide for otolaryngologists to use when making clinical decisions with patients.

Original languageEnglish (US)
Pages (from-to)871-876
Number of pages6
JournalInternational Forum of Allergy and Rhinology
Volume4
Issue number11
DOIs
StatePublished - Nov 1 2014

Fingerprint

Adrenal Cortex Hormones
Nose
Medicare
Quality of Life
Asthma
Delivery of Health Care
Costs and Cost Analysis
Therapeutics

Keywords

  • Chronic sinusitis
  • Corticosteroids
  • Health economics
  • Nasal polyps
  • Risk analysis
  • Samter's triad

ASJC Scopus subject areas

  • Immunology and Allergy
  • Otorhinolaryngology
  • Medicine(all)

Cite this

When do the risks of repeated courses of corticosteroids exceed the risks of surgery? / Leung, Randy M.; Dinnie, Keith; Smith, Timothy.

In: International Forum of Allergy and Rhinology, Vol. 4, No. 11, 01.11.2014, p. 871-876.

Research output: Contribution to journalArticle

@article{fdef338adf6242afbdaee44627daf573,
title = "When do the risks of repeated courses of corticosteroids exceed the risks of surgery?",
abstract = "Background: The management of chronic rhinosinusitis with nasal polyposis (CRSwNP) becomes unclear when patients require multiple courses of corticosteroids to maintain quality of life. Repeated courses of corticosteroids carry increased risks to patients. Although endoscopic sinus surgery (ESS) is an effective therapeutic modality, it also carries inherent risks. This study aims to identify the threshold at which the risks of repeated courses of corticosteroid exceed the risks of surgery. Methods: An evidence-based risk analysis was simulated using literature-reported complication rates, quality of life changes, and Medicare costs. Simulations were performed from the Medicare patient perspective, societal perspective, and the universal healthcare patient perspective. Results: All 3 simulations demonstrate a breakeven threshold favoring surgery over medical therapy when patients require oral corticosteroids (OCS) more often than once every 2 years in CRSwNP, once per year in CRSwNP/asthma, or twice per year for Samter's triad patients. Conclusion: This represents the first rationalized evidence-based analysis for when surgery should be considered in place of repeated courses of oral corticosteroids. This threshold provides a guide for otolaryngologists to use when making clinical decisions with patients.",
keywords = "Chronic sinusitis, Corticosteroids, Health economics, Nasal polyps, Risk analysis, Samter's triad",
author = "Leung, {Randy M.} and Keith Dinnie and Timothy Smith",
year = "2014",
month = "11",
day = "1",
doi = "10.1002/alr.21377",
language = "English (US)",
volume = "4",
pages = "871--876",
journal = "International Forum of Allergy and Rhinology",
issn = "2042-6976",
publisher = "Wiley-Blackwell",
number = "11",

}

TY - JOUR

T1 - When do the risks of repeated courses of corticosteroids exceed the risks of surgery?

AU - Leung, Randy M.

AU - Dinnie, Keith

AU - Smith, Timothy

PY - 2014/11/1

Y1 - 2014/11/1

N2 - Background: The management of chronic rhinosinusitis with nasal polyposis (CRSwNP) becomes unclear when patients require multiple courses of corticosteroids to maintain quality of life. Repeated courses of corticosteroids carry increased risks to patients. Although endoscopic sinus surgery (ESS) is an effective therapeutic modality, it also carries inherent risks. This study aims to identify the threshold at which the risks of repeated courses of corticosteroid exceed the risks of surgery. Methods: An evidence-based risk analysis was simulated using literature-reported complication rates, quality of life changes, and Medicare costs. Simulations were performed from the Medicare patient perspective, societal perspective, and the universal healthcare patient perspective. Results: All 3 simulations demonstrate a breakeven threshold favoring surgery over medical therapy when patients require oral corticosteroids (OCS) more often than once every 2 years in CRSwNP, once per year in CRSwNP/asthma, or twice per year for Samter's triad patients. Conclusion: This represents the first rationalized evidence-based analysis for when surgery should be considered in place of repeated courses of oral corticosteroids. This threshold provides a guide for otolaryngologists to use when making clinical decisions with patients.

AB - Background: The management of chronic rhinosinusitis with nasal polyposis (CRSwNP) becomes unclear when patients require multiple courses of corticosteroids to maintain quality of life. Repeated courses of corticosteroids carry increased risks to patients. Although endoscopic sinus surgery (ESS) is an effective therapeutic modality, it also carries inherent risks. This study aims to identify the threshold at which the risks of repeated courses of corticosteroid exceed the risks of surgery. Methods: An evidence-based risk analysis was simulated using literature-reported complication rates, quality of life changes, and Medicare costs. Simulations were performed from the Medicare patient perspective, societal perspective, and the universal healthcare patient perspective. Results: All 3 simulations demonstrate a breakeven threshold favoring surgery over medical therapy when patients require oral corticosteroids (OCS) more often than once every 2 years in CRSwNP, once per year in CRSwNP/asthma, or twice per year for Samter's triad patients. Conclusion: This represents the first rationalized evidence-based analysis for when surgery should be considered in place of repeated courses of oral corticosteroids. This threshold provides a guide for otolaryngologists to use when making clinical decisions with patients.

KW - Chronic sinusitis

KW - Corticosteroids

KW - Health economics

KW - Nasal polyps

KW - Risk analysis

KW - Samter's triad

UR - http://www.scopus.com/inward/record.url?scp=84933515608&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84933515608&partnerID=8YFLogxK

U2 - 10.1002/alr.21377

DO - 10.1002/alr.21377

M3 - Article

C2 - 25145900

AN - SCOPUS:84933515608

VL - 4

SP - 871

EP - 876

JO - International Forum of Allergy and Rhinology

JF - International Forum of Allergy and Rhinology

SN - 2042-6976

IS - 11

ER -