Close monitoring and treatment may often be the smarter choice, study suggests
MONDAY, Nov. 19 (HealthDay News) -- In children with mild to moderate symptoms of throat infection, surgery to remove the tonsils is more expensive, but not necessarily more beneficial, compared to simply watching and waiting to see if symptoms resolve, a Dutch study finds.
Between 2000 and 2003, researchers at the University Medical Center Utrecht compared 151 children, ages 2 to 8, who were assigned to have adenotonsillectomy (removal of tonsils and adenoids) within six weeks and 149 children assigned to watchful waiting, which involved close monitoring and interventions as necessary. Follow-ups were conducted at three, six, 12, 18 and 24 months.
Annual costs averaged about $500 per child per year in the watchful waiting group, compared with about $730 (46 percent more) in the surgery group. Children who had surgery had fewer fevers, throat infections and respiratory tract infections than those in the watchful waiting group.
"Overall, the balance between costs and effects in this population seemed unfavorable for adenotonsillectomy, with incremental cost-effectiveness ratios in excess of $423 per disease episode averted," the study authors wrote.
"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," they concluded.
The study was published in the November issue of the journal Archives of Otolaryngology -- Head & Neck Surgery.
The American Academy of Otolaryngology -- Head & Neck Surgery has more about tonsils and adenoids.
-- Robert Preidt
SOURCE: JAMA/Archives journals, news release, Nov. 19, 2007
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