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Health Care Costs and Financing

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Annual health care costs associated with sinusitis and conjunctivitis are enormous

Allergic rhinitis (AR), the typically stuffy runny nose of allergy sufferers, can lead to development or worsening of asthma, sinusitis, middle ear infections, and nasal polyps. Sinusitis also can lead to development or worsening of asthma and related airway disorders. Conversely, treatment of AR and sinusitis can reduce the severity and costs of care of these related illnesses. Treatment of allergic rhinoconjunctivitis (AR/AC) and sinusitis accounted for billions in health care costs in 1996, according to two recent studies.

Peter J. Gergen, M.D., M.P.H., of the Agency for Health Care Policy and Research participated in the studies, along with colleagues from the Medical Technology and Practice Patterns Institute, Georgetown University Medical Center, and Washington Hospital Center. They convened an expert panel to estimate the outpatient and inpatient visits with a primary or secondary diagnosis of AR/AC in the first study and sinusitis in the second study. The researchers then used data from AHCPR's 1987 National Medical Expenditure Survey (inflated to 1996 dollars) to estimate total 1996 costs for both conditions.

The overall direct medical expenditures attributable to AR/AC were $5.9 billion ($1.9 billion for the primary diagnosis and $4 billion for a secondary diagnosis). Outpatient services accounted for 63 percent ($3.7 billion), medications for 25 percent ($1.5 billion), and inpatient services for 12 percent ($0.7 billion). Children 12 years and younger accounted for 38 percent ($2.3 billion) of total costs.

Overall health care expenditures attributable to sinusitis were $5.8 billion, of which 31 percent ($1.8 billion) was for children 12 years or younger. A primary diagnosis of acute or chronic sinusitis accounted for 59 percent of all expenditures ($3.5 billion). About 12 percent of each of the costs for asthma and chronic otitis media (middle ear infections) and eustachian tube disorders were attributed to diagnosis and treatment of comorbid sinusitis (sinusitis as a secondary diagnosis). The researchers conclude that upper airway disorders need to be recognized as serious, debilitating, costly diseases that warrant precise diagnosis and effective, specific therapy.

Details of the two studies are in "Direct expenditures for the treatment of allergic rhinoconjunctivitis in 1996, including the contributions of related airway illnesses," and "Healthcare expenditures for sinusitis in 1996: Contributions of asthma, rhinitis, and other airway disorders," by Nancy F. Ray, M.S., James N. Baraniuk, M.D., Mae Thamer, Ph.D., and others, in the March 1999 Journal of Allergy and Clinical Immunology 103, pp. 401-407, and 408-414, respectively. Reprints are available (AHCPR Publication Nos. 99-R069 and 99-R068, respectively) from the AHCPR Clearinghouse.

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