Corticosteroid nasal spray delays treatment in patients with severe nasal obstruction

A mandatory use of corticosteroid nasal spray resulted in delay in treatment for patients with severe-to-extreme nasal obstruction, according to study results published in JAMA Facial Plastic Surgery.

“Many insurance companies require documentation of treatment with corticosteroid nasal spray in all patients as a requisite to preauthorization for repair of nasal stenosis or even septoplasty, regardless of anatomical findings by the physician,” researchers at Stanford University wrote.

The researchers conducted a post hoc, retrospective study of 179 adults (100 men; mean age, 37.9 years) who presented to a facial plastic and reconstructive surgery clinical with a diagnosis of nasal airway obstruction, deviated nasal septum and nasal valve stenosis between 2011 and 2013.

A cost-efficiency economic evaluation was conducted. Nasal Obstruction Symptom Evaluation (NOSE) score questionnaires were used to obtain effectiveness data.

Medical therapy with corticosteroid nasal spray vs. surgical therapy for nasal airway obstruction were the comparative treatment groups.

Eight patients reported symptomatic improvement after a course of medical therapy, while 171 patients were offered surgery after medical treatment failed. Of those, 111 patients underwent surgical correction, with postoperative NOSE scores collected at 1-, 3- and 6-month evaluations.

Cost per quality-adjusted life-year (QALY) was the primary outcome, with costs obtained from the Medicare 2015 physician fee schedule.

They found that surgical repair cost $6,537 and produced 1.15 QALYs, whereas medical treatment with corticosteroid spray cost $520 and produced 1.03 QALYs.

“The surgical approach was markedly more effective but at greater short-term cost,” the researchers wrote.

Medical treatment cost $250.73 with 1.004 QALYs in patients with extreme nasal obstruction, which demonstrated an incremental cost-effectiveness ration (ICER) of $354,693 per QALY when compared with no treatment. The cost of surgical treatment was $6,536.64 with 1.136 QALYs, for an ICER of $45,633 when compared with medical therapy.

When the evaluation was extended to 5 years, the cost of surgical treatment was $8,984 per QALY vs. $52,571 per QALY for medial treatment.

“Owing to improved effectiveness outcomes, greater cost savings per ICER was demonstrated in patients with extreme nasal obstruction,” the researchers wrote.

“Results from this study suggest that surgical treatment is likely to be the most cost-effective intervention compared with continuing medical treatment,” the researchers concluded. “These data suggest that treatment with corticosteroid nasal spray in patients with documented severe to extreme anatomical nasal obstruction is unnecessary and results in a delay in treatment.” – by Bruce Thiel

Disclosure: The researchers report no relevant financial disclosures