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Objective: Chronic rhinosinusitis (CRS) is a popular and tiring disease with significant impacts on the economy and on the Health-related Quality of Life (HRQOL) of patients. This study aims to estimate the cost of illness (COI) and to assess the Health-related Quality of Life (HRQOL) in patients with CRS who underwent surgery in Vietnam and to analyse the relationship between socio-demographic characteristics and the COI as well as the HRQOL., Methods: A cross-sectional study was conducted in Ear, Nose, Throat Hospital in Ho Chi Minh City (ENT Hospital HCMC), Vietnam between August and October 2018. The direct medical and non-medical costs, the indirect costs (productivity loss), and the HRQOL of patients with CRS were measured. A subjective assessment of quality of life (QOL) using EuroQol 5 Dimensions 5 Levels (EQ-5D-5L) was used to evaluate the health status of these patients after surgery. Characteristics related with the COI and the HRQOL were identified by multiple regression., Results: A total of 264 inpatients with CRS participated in the study. The mean COI for inpatients with CRS was $812.83 and direct costs accounted for a major proportion (89.32%) of the total cost. In addition, the surgery represented the most significant direct medical cost with 58.57% of the total cost. Most of the patients reported no problems with mobility (89.1%), self-care (93.9%), usual activities (77.2%), and anxiety/depression (64.0%). The mean EQ-5D-5L utility score was 0.76 (SD = 0.17), and the mean Visual Analogue Scale (EQ-VAS) score was 76.57 (SD = 13.34). The results of multiple regression showed that gender, occupations, monthly income, prior surgery and family history of CRS affected the total cost while the HRQOL of patients were related to education, smoking behaviour, exercise behaviour and family history of CRS., Conclusions: This study showed that although endoscopic sinus surgery (ESS) accounted for the largest expense in the COI, this surgical treatment helped to improve the HRQOL in patients with CRS. The findings provided a reference for policy makers in CRS management as well as for adjustment of costs for patients so as to reduce disease burden and to enhance their QOL.

Introduction: Management of the frontal sinus places great demands on the otolaryngologist. Given that the fronto-ethmoidal region is susceptible to recurrent inflammation, scarring, and stenosis, maintaining long-term patency of the frontal sinus is a difficult challenge. Oral and topical anti-inflammatory therapy, post-operative stenting, and 'home-brew' drug elution have been used for the treatment of the frontal sinus with mixed success. Recently an implant has been approved for post-operative placement into the frontal recess. This implant provides reliable and consistent steroid drug elution to address inflammation of the frontal recess secondary to chronic sinusitis. Areas covered: This review discusses the development and application of steroid eluting implants in the postoperative care of patients with chronic frontal sinusitis. All randomized controlled trials evaluating steroid eluting implants are discussed. Relevant supporting material discussing background, economics, safety are included. Expert commentary: Steroid eluting implants fulfill a unique niche in the treatment following frontal sinus surgery. They are shown to decrease the need for post-operative interventions and improve outcomes in patients with chronic sinusitis. There is significant potential for growth in the use of steroid eluting implants.

Background: Chronic rhinosinusitis with nasal polyps is a chronic disease frequently seen in otorhinolaryngological practice. Along with its chronic disease burden it creates high societal costs. Therapy consists of long-term use of medication and, if insufficient, endoscopic sinus surgery. No consensus exists on the right timing and extent of disease that warrants surgery. Furthermore, there is lack of clinical knowledge about the benefit of surgery over medication only. The current trial evaluates the clinical effectiveness and cost-effectiveness of endoscopic sinus surgery in addition to drug treatment versus medication exclusively in the adult patient group with nasal polyps., Methods: A prospective, multicentre, superiority, randomised controlled (PolypESS) trial in 238 patients aged 18 years or older selected for primary or revision endoscopic sinus surgery by the otorhinolaryngologist was designed. Patients will be randomised to either endoscopic sinus surgery in addition to medication or medical therapy only. Relevant data will be collected prior to randomisation, at baseline and 3, 6, 12, 18 and 24 months after start of treatment. Complete follow-up will be 24 months. Primary outcome is disease-specific Health-related Quality of Life quantified by the SNOT-22 after 12-month follow-up. Secondary outcomes are generic Health-related Quality of Life, cost-effectiveness, objective signs of disease and adverse effects of treatment. Subgroup analyses will be performed to verify whether treatment effects differ among patient phenotypes., Discussion: The PolypESS trial will investigate tailored care in adult patients with chronic rhinosinusitis with nasal polyps and will result in improved clinical pathways to help to determine in which circumstances to perform surgery., Trial Registration: Dutch Trial Register, NTR4978 . Registered on 27 November 2014.

Background: Few studies have investigated the impact of acute rhinosinusitis on disease-specific quality of life, and disease costs have not been studied previously in Scandinavia., Aims: To study symptoms, treatment patterns, quality of life and costs in adults with acute rhinosinusitis., Methods: This was an observational study in primary care. Patients aged 18-80 years seeking care for acute rhinosinusitis were evaluated using the Major Symptom Score (MSS) on days 0 and 15. Recommended and used treatments, quality of life and costs were assessed by questionnaires including EQ-5D™ and a visual analogue scale (VAS) on the same days., Results: 150 patients were enrolled; 143 provided follow-up data. The proportion of MSS responders was 91%. Mean MSS decreased from 8.4 on day 0 (N = 150) to 1.9 on day 15 (N = 143). Patients reporting pain/discomfort and problems with usual activities decreased from 88.4% to 31.5% and from 43.2% to 1.4%, respectively, and mean VAS increased from 58.7 to 79.5. Intranasal corticosteroids were the most recommended and/or prescribed drugs. Total cost for an episode was 10,260 SEK (€1,102), of which 75% were indirect costs., Conclusions: With treatment dominated by intranasal corticosteroids, a high proportion of responders and good symptom relief were seen. Acute rhinosinusitis seems to cause a high burden on quality of life and also a high cost for society.

Objectives: Use of cost-benefit analysis in occupational health increases insight into the intervention strategy that maximises the cost-benefit ratio. This study presents a methodological framework identifying the most important elements of a cost-benefit analysis for occupational health settings. One of the main aims of the methodology is to evaluate cost-benefit ratios for different stakeholders (employers, employees and society). The developed methodology was applied to two intervention strategies focused on reducing respiratory diseases., Methods: A cost-benefit framework was developed and used to set up a calculation spreadsheet containing the inputs and algorithms required to calculate the costs and benefits for all cost elements. Inputs from a large variety of sources were used to calculate total costs, total benefits, net costs and the benefit-to-costs ratio for both intervention scenarios., Results: Implementation of a covenant intervention program resulted in a net benefit of €16 848 546 over 20 years for a population of 10 000 workers. Implementation was cost-effective for all stakeholders. For a health surveillance scenario, total benefits resulting from a decreased disease burden were estimated to be €44 659 352. The costs of the interventions could not be calculated., Conclusion: This study provides important insights for developing effective intervention strategies in the field of occupational medicine. Use of a model based approach enables investigation of those parameters most likely to impact on the effectiveness and costs of interventions for work related diseases. Our case study highlights the importance of considering different perspectives (of employers, society and employees) in assessing and sharing the costs and benefits of interventions.

The prevalence of allergic rhinitis and asthma has recently increased in Korea, and both conditions are recognized as major chronic respiratory diseases requiring active intervention. The prevalence of rhinitis among asthmatic patients is high, ranging from 60 to 80%, and could seriously affect asthma severity and outcome. We suggest that allergic rhinitis should be properly evaluated in asthmatic patients to achieve better asthma control.

The present document is the result of a consensus reached by a panel of experts from European and non-European countries on Occupational Rhinitis (OR), a disease of emerging relevance which has received little attention in comparison to occupational asthma. The document covers the main items of OR including epidemiology, diagnosis, management, socio-economic impact, preventive strategies and medicolegal issues. An operational definition and classification of OR tailored on that of occupational asthma, as well as a diagnostic algorithm based on steps allowing for different levels of diagnostic evidence are proposed. The needs for future research are pointed out. Key messages are issued for each item.

Purpose: Allergic rhinitis (AR) is common among children with asthma and exacerbates asthma symptoms. To assess the incremental utilization and cost of asthma-related health services due to concomitant AR among asthmatic children., Materials and Methods: Asthma-related claims were extracted from the Korean National Health Insurance (NHI) claims database, which covers 97% of the population. Per-capita utilization and costs of asthma-related services were determined from the societal perspective., Results: Of 319,714 children (1-14 years old) with chronic asthma in 2003, 195,026 had concomitant AR (prevalence 610 per 1,000 asthmatic children). Children with AR had 1.14 times more outpatient visits, 1.30 times more emergency department (ED) visits, and 1.49 times more hospitalizations than children without AR. More children with AR used general hospitals (7.17%) than children without AR (3.23%). The ratios of unit pharmaceutical costs per outpatient visit, ED visit, and admission between children with and without AR were 1.27, 1.20, and 1.14. Total annual expenditure combining direct health care, transportation, and caregivers' costs, were $273 and $217 for children with and without AR, respectively., Conclusion: Health service utilization and costs for asthma were greater for asthmatic children with AR. More frequent ED visits and admissions among asthmatic children with AR suggest poorer control and more frequent exacerbations. Higher unit cost of pharmaceuticals during visits, tendency to receive asthma care from a higher-level facility, and greater risk of ED visit or admission all contributed to the additional economic burden of AR.

Background: A U.S. Food and Drug Administration advisory committee deemed the second-generation antihistamines (SGA) safe for over-the-counter use against the preliminary opposition of the manufacturers. As a result, loratadine is now available over-the-counter. First-generation antihistamines (FGA) are associated with an increased risk of unintentional injuries, fatalities, and reduced productivity. Access to SGA over-the-counter could result in decreased use of FGA, thereby reducing deleterious outcomes. The societal impact of transitioning this class of medications from prescription to over-the-counter status has important policy implications., Objective: To examine the cost-effectiveness of transitioning SGA to over-the-counter status from a societal perspective., Research Design: A simulation model of the decision to transition SGA to over-the-counter status was compared with retaining prescription-only status for a hypothetical cohort of individuals with allergic rhinitis in the United States. Estimates of costs and effectiveness were obtained from the medical literature and national surveys. Sensitivity analysis was performed using a second-order Monte Carlo simulation., Main Outcome Measures: Discounted, quality-adjusted life-years saved as a result of amelioration of allergic rhinitis symptoms and avoidance of motor vehicle, occupational, public and home injuries and fatalities; discounted direct and indirect costs., Results: Availability of SGA over-the-counter was associated with annual savings of 4 billion dollars (2.4-5.3 billion dollars) or 100 dollars (64-137 dollars) per allergic rhinitis sufferer and 135,061 time-discounted quality-adjusted life years (84,913-191,802). The sensitivity analysis provides evidence in support of these results., Conclusion: Making SGA available over-the-counter is both cost-saving and more effective for society, largely as a result of reduced adverse outcomes associated with FGA-induced sedation. Further study is needed to determine the differential impact on specific vulnerable populations.