20, 2012 Health Technology Assessment Imaging for Rhinosinusitis Final Evidence Report April 3, 2015 Health Technology Assessment Program (HTA) Washington State Health Care Authority PO Box 42712 Olympia, WA 98504-2712 (360) 725-5126 hca.wa.gov/hta [email protected] Imaging for Rhinosinusitis A Health Technology Assessment Prepared for Washington State Healthcare Authority FINAL REPORT April 3, 2015 Acknowledgement This report was prepared by: Hayes, Inc. 157 S. Broad Street Suite 200 Lansdale, PA 19446 P: 215.855.0615 F: 215.855.5218 This report is intended to provide research assistance and general information only. It is not intended to be used as the sole basis for determining coverage policy or defining treatment protocols or medical modalities, nor should it be construed as providing medical advice regarding treatment of an individual’s specific case. 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WA – Health Technology Assessment April 3, 2015 Table of Contents EXECUTIVE SUMMARY .................................................................................................................................. 1 Summary of Clinical Background .............................................................................................................. 1 Rhinosinusitis: Prevalence and Clinical Definition ................................................................................ 1 Predisposing Factors ............................................................................................................................. 2 Objective Confirmation of RS ................................................................................................................ 2 Radiographic Staging ............................................................................................................................. 3 Safety of Imaging .................................................................................................................................. 4 Treatment of RS .................................................................................................................................... 4 Policy Context ........................................................................................................................................... 6 Summary of Review Objectives and Methods .......................................................................................... 6 Review Objectives ................................................................................................................................. 6 Key Questions ....................................................................................................................................... 6 Analytic Framework .............................................................................................................................. 7 Methods .................................................................................................................................................... 7 Search Strategy and Selection Criteria .................................................................................................. 7 Inclusion Criteria ................................................................................................................................... 7 Exclusion Criteria ................................................................................................................................... 8 Quality Assessment ............................................................................................................................... 8 Summary of Search Results....................................................................................................................... 9 Findings ..................................................................................................................................................... 9 Key Question #1 .................................................................................................................................... 9 Key Question #1: What is the clinical performance (accuracy) of imaging technologies such as CT, MRI, x-ray, and US for evaluation of rhinosinusitis or related complications? #1a: Does the clinical performance vary by imaging modality or technique? ......................................................................... 9 Key Question #2 .................................................................................................................................. 18 Key Question #2: What is the clinical utility of imaging for rhinosinusitis, i.e., what is the impact on clinical management decisions, on utilization (Key Question #2a) and on health outcomes (Key Question #2b), and according to different imaging modalities (Key Question #2c)? ......................... 18 Key Question #3 .................................................................................................................................. 20 Key Question #3: What are the safety issues associated with different forms of imaging technologies? ...................................................................................................................................... 20 Key Question #4 .................................................................................................................................. 21 Imaging for Rhinosinusitis: Final Evidence Report Page iii WA – Health Technology Assessment April 3, 2015 Key Question #4: Does the diagnostic performance, impact on clinical management, impact on health outcomes, or incidence of adverse events vary by clinical history or patient characteristics (e.g., comorbidities, subtypes of rhinosinusitis)? ............................................................................... 21 Key Question #5 .................................................................................................................................. 22 Key Question #5: What are the cost and cost-effectiveness of imaging modalities in the diagnosis of sinusitis, including comparative costs and incremental cost-effectiveness when comparing modalities? .......................................................................................................................................... 22 Practice Guidelines.................................................................................................................................. 25 Classification and Diagnosis of RS ....................................................................................................... 25 Imaging for RS ..................................................................................................................................... 26 Choosing Wisely .................................................................................................................................. 27 Selected Payer Policies ............................................................................................................................ 28 Overall Summary and Discussion ............................................................................................................ 29 Evidence-Based Summary Statement ................................................................................................. 29 Gaps in the Evidence ........................................................................................................................... 30 TECHNICAL REPORT .................................................................................................................................... 31 Clinical Background ................................................................................................................................. 31 Rhinosinusitis: Prevalence and Clinical Definition .............................................................................. 31 Predisposing Factors ........................................................................................................................... 31 Objective Confirmation of RS .............................................................................................................. 32 Safety of Imaging ................................................................................................................................ 34 Treatment of RS .................................................................................................................................. 35 Review Objectives and Analytic Framework ........................................................................................... 40 Scope ................................................................................................................................................... 40 Key Questions ..................................................................................................................................... 40 Analytic Framework ............................................................................................................................ 41 Methods .................................................................................................................................................