TY - JOUR
T1 - Treatment practices for aspirin-exacerbated respiratory disease
T2 - analysis of a national insurance claims database
AU - Roland, Lauren T.
AU - Nagy, Celeste
AU - Wang, Heqiong
AU - Moore, Renee
AU - Cahill, Katherine N.
AU - Laidlaw, Tanya M.
AU - Wise, Sarah K.
AU - DelGaudio, John M.
AU - Kuruvilla, Merin
AU - Levy, Joshua M.
N1 - Funding Information:
sources for the study: Triological Society Research Career Development Award; NIH (National Center for Advancing Translational Sciences [NCATS]: KL2TR002381, UL1TR002378 to J.M.L.); Lyle Finley Foundation.
Funding Information:
A very small percentage of AERD patients undergo AsaD. Patients who had AsaD underwent surgery approximately 2 months prior to AsaD. Patients who underwent AsaD experienced an increased time between surgeries compared to patients who did not undergo AsaD. Funding sources for the study: Triological Society Research Career Development Award; NIH (National Center for Advancing Translational Sciences [NCATS]: KL2TR002381, UL1TR002378 to J.M.L.); Lyle Finley Foundation. Potential conflict of interest: S.K.W.: Consultant (Stryker, NeurENT), Scientific Advisory Board (OptiNose, SinopSys Surgical, ALK‐Abello). J.M.D.: Consultant (Medtronic), Research support (Spirox). K.N.C.: Advisory Board (Teva, Regeneron, Novartis). T.M.L.: Advisory Board (GlaxoSmithKline, Regeneron). No conflicts of interest reported for L.T.R., C.N., H.W., and R.M. Presented at the Annual ARS Meeting on September 13‐14, 2019, in New Orleans, LA. Aspirin‐exacerbated respiratory disease (AERD) is defined as an inflammatory disease with 3 clinical features: asthma, nasal polyps, and nonsteroidal anti‐inflammatory drug (NSAID) sensitivity to all COX‐1 inhibitors. Approximately 1,368,000 patients are thought to have AERD within the United States, based on the estimated prevalence of asthma in this country and estimates of AERD within the asthma population. AsaD has been shown to be cost effective because for many patients revision surgery can then be delayed or avoided. Several treatment options for AERD exist: medical therapy including biologic therapy, functional endoscopic sinus surgery, and aspirin desensitization (AsaD). Due to regrowth of polyps, patients often require several revision surgeries in their lifetime. AsaD is recommended after surgery to help avoid recurrence of nasal polyps. Aspirin maintenance following desensitization requires commitment from the patient to adhere to long‐term aspirin intake, and side effects include gastritis and gastrointestinal (GI) or other bleeding. Additionally, although desensitization protocols have shortened in duration, 1 to 2 days are required for current protocols, which may be a burden to the patient. Barriers to drug desensitization include the need for specific training to perform AsaD. In a recent survey study of allergists in the United States, only 62.5% of participants reported performance of AsaD for AERD patients and most performed <5 procedures per year. Yet the treatment practices for AERD are variable and have not been well studied. Therefore, despite evidence of patient tolerance and safety, resources for AsaD are not universally accessible to AERD patients. Multiple trials have shown that AsaD is beneficial to AERD patients with reduction in prescription use and improved quality of life. The MarketScan database contains insurance claim information for over 20 billion patient encounters between 2009 and 2015 ( https://truvenhealth.com ; now IBM Watson Health, Armonk, NY). The database can be queried for patient diagnoses and procedures using International Classification of Diseases, 9th edition (ICD‐9) and Current Procedural Terminology (CPT) coding. The aim of this study was to evaluate the current treatment practices for AERD in the United States using a large national insurance claims database.
Publisher Copyright:
© 2019 ARS-AAOA, LLC
PY - 2020/2/1
Y1 - 2020/2/1
N2 - Background: Aspirin-exacerbated respiratory disease (AERD) is the triad of asthma, nasal polyposis, and sensitivity to cyclooxygenase-1 inhibitors. Treatment options include medical management, surgical intervention, and aspirin desensitization (AsaD). Methods: AERD patients were identified using the MarketScan Database from 2009 to 2015. Patients were included using International Classification of Diseases, 9th edition (ICD-9) codes for asthma, nasal polyposis, and drug allergy. Treatments were determined by Current Procedural Terminology (CPT) codes for drug desensitization and endonasal procedures. Geographic trends and timing of interventions between those exposed and not exposed to desensitization were explored. Results: A total of 5628 patients met inclusion criteria for AERD, with mean age 46 years, 60% female; 395 (7%) underwent AsaD and 2171 (39%) underwent sinus surgery. Among patients who were desensitized, 229 (58%) underwent surgery, of whom 201 (88%) had surgery prior to AsaD (median [quartile 1, quartile 3]; 61 days [30, 208] prior to desensitization). For patients undergoing surgery following AsaD (n = 46), surgery was performed a median of 302 (163, 758) days after AsaD. Nineteen patients had multiple surgeries post-AsaD with median time between surgeries being 734 days (312, 1484); 261 patients were not desensitized to aspirin but did undergo multiple surgeries, with the median of the median time between surgeries being 287 days (15, 617), which is shorter than for patients post-AsaD (p < 0.001). Conclusion: A very small percentage of AERD patients undergo AsaD. Patients who had AsaD underwent surgery approximately 2 months prior to AsaD. Patients who underwent AsaD experienced an increased time between surgeries compared to patients who did not undergo AsaD.
AB - Background: Aspirin-exacerbated respiratory disease (AERD) is the triad of asthma, nasal polyposis, and sensitivity to cyclooxygenase-1 inhibitors. Treatment options include medical management, surgical intervention, and aspirin desensitization (AsaD). Methods: AERD patients were identified using the MarketScan Database from 2009 to 2015. Patients were included using International Classification of Diseases, 9th edition (ICD-9) codes for asthma, nasal polyposis, and drug allergy. Treatments were determined by Current Procedural Terminology (CPT) codes for drug desensitization and endonasal procedures. Geographic trends and timing of interventions between those exposed and not exposed to desensitization were explored. Results: A total of 5628 patients met inclusion criteria for AERD, with mean age 46 years, 60% female; 395 (7%) underwent AsaD and 2171 (39%) underwent sinus surgery. Among patients who were desensitized, 229 (58%) underwent surgery, of whom 201 (88%) had surgery prior to AsaD (median [quartile 1, quartile 3]; 61 days [30, 208] prior to desensitization). For patients undergoing surgery following AsaD (n = 46), surgery was performed a median of 302 (163, 758) days after AsaD. Nineteen patients had multiple surgeries post-AsaD with median time between surgeries being 734 days (312, 1484); 261 patients were not desensitized to aspirin but did undergo multiple surgeries, with the median of the median time between surgeries being 287 days (15, 617), which is shorter than for patients post-AsaD (p < 0.001). Conclusion: A very small percentage of AERD patients undergo AsaD. Patients who had AsaD underwent surgery approximately 2 months prior to AsaD. Patients who underwent AsaD experienced an increased time between surgeries compared to patients who did not undergo AsaD.
KW - AERD
KW - aspirin desensitization
KW - asthma
KW - chronic rhinosinusitis
KW - sinusitis
UR - http://www.scopus.com/inward/record.url?scp=85074838995&partnerID=8YFLogxK
U2 - 10.1002/alr.22471
DO - 10.1002/alr.22471
M3 - Article
C2 - 31693796
AN - SCOPUS:85074838995
VL - 10
SP - 190
EP - 193
JO - International Forum of Allergy and Rhinology
JF - International Forum of Allergy and Rhinology
SN - 2042-6976
IS - 2
ER -