Trends in Procedural Management of Meniere's Disease: Analysis of a National Insurance Claims Database.

ABSTRACT

Objective: This study used a national insurance claims database to analyze trends in procedural management of Meniere's disease. Study Design: Retrospective cohort analysis. Setting: Database study using United States inpatient and outpatient insurance claims submitted from January 2003 to December 2021. Subjects and Methods: The Merative MarketScan Commercial and Medicare Claims Databases were queried for adults (≥18 years) with a diagnosis of Meniere's Disease according to International Classification of Diseases codes. Patients receiving procedures per Current Procedural Terminology codes for endolymphatic sac surgery, vestibular nerve section, labyrinthectomy, and intratympanic dexamethasone or gentamicin were identified. Temporal trends were analyzed by calculating annual percent change (APC) in the proportion of patients receiving procedures using Joinpoint regression. Results: A total of 16,523 unique patients with MD receiving procedural management were identified. From 2003 to 2021, the proportion of patients managed with intratympanic dexamethasone increased (APC 1.76 [95% CI 1.53-1.98], P < .001). The proportion of patients receiving intratympanic gentamicin increased from 2003 to 2015 (APC 4.43 [95% CI 1.29-7.66], P = .008) but decreased from 2015 to 2021 (APC -10.87 [95% CI -18.31 to -2.76], P = .013). The proportion of patients receiving endolymphatic sac surgery (APC -10.20 [95% CI -11.19 to -9.20], P < .001) and labyrinthectomy (APC -6.29 [95% CI -8.12 to -4.42], P < .001) decreased from 2003 to 2021. Conclusion: From 2003 to 2021, there has been an increase in the use of intratympanic dexamethasone and a decrease in the use of intratympanic gentamicin, endolymphatic sac surgery, and labyrinthectomy for procedural management of Meniere's Disease.