Navigation Links
The great tonsil dilemma
Date:2/8/2011

ANN ARBOR, Mich. Without fanfare, hundreds of thousands of children surrender their tonsils to a surgeon's scalpel each year, usually to alleviate recurring infections and obstructive sleep problems. Most of the time, the snipped tonsils are sent to a pathologist, who looks for evidence of more serious medical problems, like unsuspected cancer.

But this common practice may not be cost-effective because those additional examinations rarely lead to the discovery of hidden disease, a new University of Michigan Heath System analysis shows.

The approximately $35 million spent nationwide on such examinations each year might have more impact if spent elsewhere in the healthcare system, says the study's senior author, Marc C. Thorne, M.D., M.P.H., assistant professor of otolaryngology at the U-M Medical School.

"The question is: How do we make rational use of our heath care dollars?" asks Thorne. "It's a matter both of economics and of societal values."

The findings, published online ahead of print publication in the journal OtolaryngologyHead and Neck Surgery, are but a single example from the larger, ongoing debate about how to best conserve resources, create efficiencies and lower the cost of health care.

Pathologists examine tonsillectomy specimens in two ways: a visual, or "gross," examination and microscopy. Microscopic examination is nearly three times more expensive than visual inspection.

Forty-two percent of specimens receive gross analysis, 38 percent are examined under the microscope and 20 percent are discarded without examination, according to a 2001 survey of American Academy of Otolaryngology members.

To determine the effectiveness of each practice, Thorne and his colleagues pored over data from 5,235 tonsillectomies conducted at U-M between 1996 and 2008.

A pathologist performed a visual examination in 4,186 of those cases and zero cases of additional disease were identified. Meanwhile, the collective cost of those examinations is roughly $150,000.

"Looking grossly might seem like next best alternative to the expense of putting every specimen under the microscope," Thorne says. "But it may be the worst of both worlds the data show you're unlikely to find anything, but you're still incurring significant expense."

While better at identifying disease, microscopic examination also turned up few unsuspected problems. The incidence is so low that the researchers estimated over $750,000 would need to be spent for every case of lymphoma found.

Out of 1,066 microscopic examinations, 18 cases of disease were found, all of which were suspected before surgery either because a patient was known to be at higher risk because they had previously received an organ transplant or a surgeon noticed something suspicious and requested additional scrutiny.

No one is suggesting that discovering hidden cancers and other diseases isn't important, Thorne says. The question is what we might be giving up elsewhere in order to find those rare cases.

Part of the problem is a disconnect between the service and the payment. For a parent with insurance, there might be no additional out-of-pocket cost to have their child's tonsil's examined under a microscope. But as a society we have to balance those individual desires with the burden on the overall system, Thorne explains.

"If we're going to make a rational decision say, 'I don't care how much it costs, missing a lymphoma in a child is unacceptable' then we should be doing microscopy all the time. If we're just doing gross analysis, we're still spending a lot of money, yet we know we're unlikely to find anything that way."

Still, routine analysis has some non-clinical benefits, such as its use in training pathologists, the authors note.

Jonathan McHugh, M.D., an assistant professor of pathology at U-M Medical School and one of the study's authors, says some pathologists may be resistant to change because they think of themselves as the last line of defense.

"In this instance, I think the data shows we haven't been that valuable in that role," McHugh says.


'/>"/>

Contact: Ian Demsky
idemsky@umich.edu
734-764-2220
University of Michigan Health System
Source:Eurekalert

Related medicine news :

1. Laser Spine Institute Honored at the Gridiron Greats Night of Champions
2. Jion Beijing Great Wall International Travel Agency Immediate Exposure to China Expo 2010
3. Akron Institute of Herzing University Launches Its First Bachelors Degree Programs to Prepare Students for Even Greater Success in Business, Health Care and IT
4. USA's Greatest Speed Skater Takes His Medical Practice to the Cutting Edge
5. Chronic Migraines Take a Greater Toll
6. Great Salt Lake Chapter of National Contract Management Association Hosts Presentation on False Claims Act by Qui Tam Attorney Tim Terry
7. Overweight middle-aged adults at greater risk for cognitive decline in later life
8. Lumension Enhances Compliance and IT Risk Management Solution for Greater IT GRC Efficiency
9. Co-Creator of Six Sigma Unveils “The Great Discovery” ... the 4th Generation of Six Sigma
10. KIWI Magazine Announces the Next Great Young Chef Contest--for Kids Who Love to Cook
11. Genetic variant greatly increases lung cancer risk for light smokers
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:5/27/2016)... Los Angeles, CA (PRWEB) , ... May 27, 2016 , ... ... Institutes of Health, so it is not surprising that bariatric surgery has received increased ... Baltimore Business Journal explains. Of course, when it comes to weight loss, most people ...
(Date:5/27/2016)... ... 27, 2016 , ... With over 60 percent of acute stroke survivors being ... product to aid in the rehabilitation process has steadily increased. Ekso Bionics had been ... hemiplegia due to stroke. , Ekso Bionics has now received clearance from the U.S. ...
(Date:5/27/2016)... ... May 27, 2016 , ... Aimed at ... inspiring human interest stories, courtesy of leaders in the nursing and health care ... industry, from leading advocates and associations—namely Jones & Bartlett Learning. , Jones & ...
(Date:5/26/2016)... ... May 26, 2016 , ... There are many ways to cook a hot ... suggests that Americans prefer their dogs straight off the grill. Of the 90 percent ... favorite way to cook a hot dog, far outpacing other cooking methods such as ...
(Date:5/26/2016)... ... May 26, 2016 , ... Connor Sports, through its Connor ... for the Tamika Catchings Legacy Tour that will commemorate the Indiana Fever ... basketball surfaces in all forms and levels of the game, Connor Sports has committed ...
Breaking Medicine News(10 mins):
(Date:5/25/2016)... , Germany and ... QIAGEN N.V. (NASDAQ: QGEN ; Frankfurt Prime ... a licensing and co-development agreement with Therawis Diagnostics GmbH to ... will be to develop and market PITX2 as a marker ... other high-risk breast cancer patients. "We are pleased ...
(Date:5/25/2016)... Florida , May 25, 2016 ... Conference & Expo earlier this month, the numbers and ... revenues continue to climb into the billions, more research ... newly released 4th Edition State of Legal Marijuana Markets ... a cannabis-focused data-analysis firm, much of the increase in ...
(Date:5/25/2016)... 25, 2016 Inivata, a ... of circulating tumour DNA (ctDNA) analysis to improve ... of Professor Clive Morris as Chief ... the clinical development programme, scientific collaborations, and through ... significant improvements in clinical outcomes for patients. ...
Breaking Medicine Technology: