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 euro803 (the average exchange rate for the US dollar in 2002 was $1.00 = euro1.1, except toward the end of 2002 when $0.95 = euro100) and euro551 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 euro1136, euro1187, and euro465, 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. .