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:6/25/2016)... FL (PRWEB) , ... June 25, 2016 , ... The temporary closing of Bruton Memorial ... Plant City Observer , brings up a new, often overlooked aspect of head lice: the ... closing for fumigation is not a common occurrence, but a necessary one in the event ...
(Date:6/25/2016)... ... June 25, 2016 , ... On Friday, June 10, ... Bronze Wellness at Work award to iHire in recognition of their exemplary accomplishments in ... the 7th annual Maryland Workplace Health & Wellness Symposium at the BWI Marriott in ...
(Date:6/24/2016)... ... ... in a crisis. Her son James, eight, was out of control. Prone to extreme mood ... something upset him, he couldn’t control his emotions,” remembers Marcy. “If there was a ... children and say he was going to kill them. If we were driving on ...
(Date:6/24/2016)... ... June 24, 2016 , ... Topical BioMedics, Inc, makers of Topricin and MyPainAway Pain Relief ... a minimum wage raise to $12 an hour by 2020 and then adjusting it yearly ... lost value of the minimum wage, assure the wage floor does not erode again, and ...
(Date:6/24/2016)... ... June 24, 2016 , ... ... feeding the Frederick area economy by obtaining investment capital for emerging technology companies. ... 2½ years that have already resulted in more than a million dollars of ...
Breaking Medicine News(10 mins):
(Date:6/24/2016)... India , June 24, 2016 ... Needles Market by Type (Standard Pen Needles, Safety Pen ... Therapy (Insulin, GLP-1, Growth Hormone), Mode of Purchase (Retail, ... by MarketsandMarkets, This report studies the market for the ... expected to reach USD 2.81 Billion by 2021 from ...
(Date:6/23/2016)... , June 23, 2016 Research and ... Global Market - Forecast to 2022" report to their ... treatment method for the patients with kidney failure, it replaces ... fluid from the patient,s blood and thus the treatment helps ... and chloride in balance. Increasing number of ...
(Date:6/23/2016)... 23, 2016 Research and Markets has ... Market Analysis 2016 - Forecast to 2022" report to ... report contains up to date financial data derived from varied ... major trends with potential impact on the market during the ... segmentation which comprises of sub markets, regional and country level ...
Breaking Medicine Technology: