Recurrent acute rhinosinusitis: epidemiology and health care cost burden

Otolaryngol Head Neck Surg. 2012 Feb;146(2):307-12. doi: 10.1177/0194599811426089. Epub 2011 Oct 25.


Objectives: To determine the epidemiology of recurrent acute rhinosinusitis (RARS) and to understand direct health care costs attributable to RARS as a potentially underdiagnosed form of chronic rhinosinusitis.

Study design: Retrospective longitudinal analysis of a medical claims database.

Setting: Academic medical center.

Methods: Medical claims data (2003-2008) from a large payer database were analyzed. Adult patients with RARS (defined as at least 4 acute rhinosinusitis claims each with a filled oral antibiotic prescription in a 12-month period) were extracted. Sinonasal diagnostic procedures, provider visits, and medical costs were determined.

Results: A total of 4588 patients were identified (mean age, 43.5 years; 72.1% female) among 13.1 million patients, for a point prevalence of 0.035%, which remained consistent across years. After 1, 2, and 4 years, 2.4%, 5.4%, and 9.2% of patients subsequently received nasal endoscopy and 11.4%, 23.5%, and 39.9% received paranasal sinus computed tomography, respectively. RARS patients averaged 3.8 antibiotic prescriptions, 5.6 other sinus-related prescriptions, and 5.6 provider visits per year. Total direct health care costs related to RARS averaged $1091/patient-year, with oral antibiotic and nasal prescription costs averaging $210 and $452 per year, respectively.

Conclusions: RARS may affect approximately 1 in 3000 adults per year. Despite significant direct health care costs of more than $1000/year per individual patient with RARS, nasal endoscopy and computed tomography are not commonly obtained early after potential diagnosis. RARS is likely an underdiagnosed condition warranting further study.

Keywords: chronic sinusitis; computed tomography; disease burden; economic burden; nasal endoscopy; recurrent acute rhinosinusitis; sinusitis.

MeSH terms

  • Acute Disease
  • Adult
  • Cost of Illness*
  • Endoscopy
  • Female
  • Health Care Costs*
  • Humans
  • Longitudinal Studies
  • Male
  • Recurrence
  • Retrospective Studies
  • Rhinitis / complications
  • Rhinitis / economics*
  • Rhinitis / epidemiology*
  • Rhinitis / therapy
  • Sinusitis / complications
  • Sinusitis / economics*
  • Sinusitis / epidemiology*
  • Sinusitis / therapy