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When do the risks of repeated courses of corticosteroids exceed the risks of surgery?
Author(s) -
Leung Randy M.,
Dinnie Keith,
Smith Timothy L.
Publication year - 2014
Publication title -
international forum of allergy and rhinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.503
H-Index - 46
eISSN - 2042-6984
pISSN - 2042-6976
DOI - 10.1002/alr.21377
Subject(s) - medicine , asthma , chronic rhinosinusitis , nasal polyps , quality of life (healthcare) , complication , perspective (graphical) , corticosteroid , sinusitis , endoscopic sinus surgery , intensive care medicine , surgery , physical therapy , nursing , computer science , artificial intelligence
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.