Cost-Effectiveness Analysis of Intracapsular Tonsillectomy and Total Tonsillectomy for Pediatric Obstructive Sleep...

Area of Science:

• Health Economics
• Otolaryngology
• Pediatric Surgery

Background:

• Pediatric obstructive sleep apnea (OSA) significantly impacts children's health and quality of life.
• Tonsillectomy is a common surgical intervention for pediatric OSA.
• Evaluating the cost-effectiveness of different tonsillectomy techniques is crucial for healthcare resource allocation.

Purpose of the Study:

• To compare the cost-effectiveness of traditional total tonsillectomy versus partial intracapsular tonsillectomy for pediatric OSA from a US Medicare perspective.
• To inform clinical and policy decisions regarding the optimal surgical approach for pediatric OSA.

Main Methods:

• A decision-tree model was utilized for economic evaluation.
• Data on procedural costs, effectiveness, and probabilities were sourced from medical literature and Medicare values.
• Cost-effectiveness was measured using the incremental cost-effectiveness ratio (ICER) and quality-adjusted life years (QALYs), with a willingness-to-pay threshold of $100,000/QALY.

Main Results:

• Base case analysis indicated total tonsillectomy as more cost-effective ($12,453.40 per QALY gained).
• Probabilistic sensitivity analysis (PSA) showed total tonsillectomy to be the preferred strategy in 82.84% of simulations.
• Deterministic sensitivity analyses revealed partial tonsillectomy could be more cost-effective if OSA recurrence rates are below 3.12% or partial tonsillectomy failure rates are below 1.0%.

Conclusions:

• Monopolar-technique total tonsillectomy is generally more cost-effective for pediatric OSA.
• Partial intracapsular tonsillectomy may offer superior cost-effectiveness under specific scenarios, particularly with lower complication and recurrence rates.