This presentation is part of: Poster Session - Utility Theory; Health Economics; Patient & Physician Preferences; Simulation; Technology Assessment
COST-EFFECTIVENESS OF CHILDHOOD ADENOTONSILLECTOMY; A RANDOMISED COMPARISON WITH WATCHFUL WAITING
E. Buskens1, B Van Staaij1, J Van den Akker2, AW Hoes1, and AGM Schilder2. (1) University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Utrecht, Netherlands, (2) University Medical Center Utrecht, Otorhinolaryngology, Utrecht,, Netherlands
Purpose Evidence regarding the cost- effectiveness of adenotonsillectomy for the majority of children currently undergoing this intervention in the Netherlands is lacking. The objective of this study was to assess the balance between costs and effects of adenotonsillectomy in children with milder symptoms of throat infections or adenotonsillar hypertrophy. Methods Economic evaluation alongside an open randomised controlled trial. Setting: Multi-center: 21 general and 3 university hospitals in the Netherlands. Participants 300 children, aged 2-8 years considered eligible for adenotonsillectomy. Excluded were children with 7 or more throat infections in previous year and those with a high suspicion of obstructive sleep apnoea. Interventions: Adenotonsillectomy versus watchful waiting. Main outcome measures: Incremental cost-effectiveness in terms of costs per episode of fever avoided, per throat infection avoided and per upper respiratory infection avoided at one year were estimated. Results Costs incurred in the adenotonsillectomy group were € 1,196 as opposed to €804 in the watchful waiting group (49% increase; 100% certain). During a median follow-up period of 22 months children in the adenotosillectomy group experienced fewer episodes of fever 0.21 (95% CI 0.54 to -0.12), throat infections 0.21 (0.36 to 0.06) and upper respiratory infections 0.53 (0.97 to 0.08) per person per year. Pertaining incremental cost per episode avoided were €2,333, €1,444 and €788 respectively. Conclusion For the majority of Dutch children currently undergoing adenotonsillectomy, i.e., with relatively mild symptoms or adenotonsillar hypertrophy, operation results in a significant increase in costs without relevant clinical benefit. Additional research is required to identify subgroups in which operation may be worthwhile.
