This Article  • Full text  • PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (1)  • Contact me when this article is cited  Related Content  • Related letter  • Similar articles in this journal  Topic Collections  • Pediatric Otolaryngology  • Otolaryngology/ Head & Neck Surgery, Other  • Randomized Controlled Trial  • Alert me on articles by topic

A Randomized Comparison of Costs and Effects

Erik Buskens, MD, PhD; Birgit van Staaij, MD, PhD; Jet van den Akker, MD, PhD; Arno W. Hoes, MD, PhD; Anne G. M. Schilder, MD, PhD

Arch Otolaryngol Head Neck Surg. 2007;133(11):1083-1088.

Objective  To evaluate the cost-effectiveness of adenotonsillectomy compared with watchful waiting in Dutch children.

Design  Economic evaluation along with an open, randomized, controlled trial.

Setting  Multicenter, including 21 general and 3 university hospitals in the Netherlands.

Participants  Three hundred children aged 2 to 8 years were selected for adenotonsillectomy according to routine medical practice. Excluded were children who had frequent throat infections and those with suspected obstructive sleep apnea.

Main Outcome Measures  Incremental cost-effectiveness in terms of costs per episode of fever, throat infection, and upper respiratory tract infection avoided.

Results  Annual costs incurred in the adenotonsillectomy group were 803 (the average exchange rate for the US dollar in 2002 was $1.00 = 1.1, except toward the end of 2002 when $0.95 = 100) and 551 in the watchful waiting group (46% increase). During a median follow-up of 22 months, surgery compared with watchful waiting reduced the number of episodes of fever and throat infections by 0.21 per person-year (95% confidence interval, –0.12 to 0.54 and 0.06 to 0.36, respectively) and upper respiratory tract infections by 0.53 (95% confidence interval, 0.08 to 0.97) episodes. The incremental costs per episode avoided were 1136, 1187, and 465, respectively.

Conclusions  In children undergoing adenotonsillectomy because of mild to moderate symptoms of throat infections or adenotonsillar hypertrophy, surgery resulted in a significant increase in costs without realizing relevant clinical benefit. Subgroups of children in whom surgery would be cost-effective may be identified in further research.

Trial Registration  isrctn.org Identifier: ISRCTN04973569

Author Affiliations: Julius Center for Health Sciences and Primary Care (Drs Buskens, van Staaij, and Hoes) and Department of Otorhinolaryngology, Wilhelmina Children's Hospital (Drs van den Akker and Schilder), University Medical Center Utrecht, Utrecht; and Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen (Dr Buskens), the Netherlands.

RELATED LETTER

Indications for Tonsillectomy: Setting the Bar High Enough
Jack L. Paradise
Arch Otolaryngol Head Neck Surg. 2008;134(6):673.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Indications for Tonsillectomy: Setting the Bar High Enough
Paradise
Arch Otolaryngol Head Neck Surg 2008;134:673-673.
FULL TEXT