A Dutch study suggests that among children with mild or moderate symptoms of throat infections, surgery to remove the tonsils may be more expensive but not necessarily more beneficial than watchful waiting, according to a report in the November issue of Archives of Otolaryngology–Head & Neck Surgery, one of the JAMA/Archives journals.
Tonsillectomy—removal of the tonsils—with or without removal of the adenoids (tissue at the back of the throat) is one of the most frequently performed surgical procedures on children, according to background information in the article. However, the number of procedures performed varies widely by country. In 1998, adenotonsillectomies were performed on 115 per 10,000 children in the
Erik Buskens, M.D., Ph.D., of University Medical Center Utrecht,
Throughout the study, annual costs among the watchful waiting group were about €551 or $500 (at the 2002 exchange rate) per year, while the group undergoing surgery had costs of €803 or about $730—a 46 percent increase. Children in the adenotonsillectomy group experienced fewer fevers and throat infections (.21 per child per year) and upper respiratory tract infections (.53 fewer per child per year). “The incremental costs per episode of fever, throat infection and respiratory tract infection avoided were €1,136 ($1,033), €1,187 ($1,079) and €465 ($423), respectively,” the authors write.
“Overall, the balance between costs and effects in this population seemed unfavorable for adenotonsillectomy, with incremental cost-effectiveness ratios in excess of €465 ($423) per disease episode averted,” they continue. “Note that this estimate includes societal costs such as parental leave of absence associated with their child’s illness. Had these costs been left out of the equation, the figures would be even somewhat less favorable. With time, the child’s immune system matures and the difference in adverse episodes disappears. Thus, the initial cost increment in the adenotonsillectomy group will never be counterbalanced by a continued positive health effect.”
The authors note that in the
Arch Otolaryngol Head Neck Surg. 2007; 133(11):1083-1088.