Healthcare Utilization After Biologic Initiation for Chronic Rhinosinusitis

Abstract

Background Biologic therapies for chronic rhinosinusitis with nasal polyps (CRSwNP) broaden options beyond endoscopic sinus surgery (ESS) and conventional medications. However, the short-term impact of biologic therapy on healthcare utilization relative to ESS is unclear. Objective To compare 12-month healthcare utilization and costs after biologic initiation versus ESS. Methods Using the Atropos Health platform (2019-2024; ∼66 million patients), adults with CRSwNP and ≥12-month follow-up who received treatment with ESS or an approved biologic were identified. After 1:1 propensity-score matching, 12-month outcomes were compared, including medication use, CRSwNP-related visits, subsequent sinus surgery, complications, and Current Procedural Terminology (CPT)-based costs. Results Of 7519 ESS and 2084 biologic-treated eligible patients, 998 remained per arm after matching. Biologics and ESS patients had similar office (41.3% vs 38.7%; OR 0.90, 95% CI 0.77-1.07) and ED visit rates (2.0% vs 1.3%; OR 0.65, 95% CI 0.32-1.30). Subsequent sinus surgery was more frequent after biologics (3.6% vs 12.9%; OR 3.97, 95% CI 2.71-5.80). No significant differences were identified in CPT-based costs, complication rates, or steroid use. Conclusions Within 1 year, ESS and biologic patients showed similar healthcare utilization, with the exception of subsequent sinus surgery rates, which were higher in biologic patients. These findings may guide shared decision-making and payer policy.