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Cost Benefit and Utility Decision Analysis of Turbinoplasty with Adenotonsillectomy for Pediatric Sleep-Disordered

Grace Baik1, Scott E Brietzke2

  • 11 Department of Otolaryngology-Head and Neck Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.

Otolaryngology--Head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery
|April 24, 2019
PubMed

Insights

Adding turbinoplasty to tonsillectomy/adenoidectomy (T/A) surgery for pediatric obstructive sleep-disordered breathing (oSDB) improves outcomes and is cost-effective. This combined approach offers better utility gains and cost benefits, even with modest improvements.

Area of Science:

  • Otolaryngology
  • Pediatric Surgery
  • Health Economics

Background:

  • Obstructive sleep-disordered breathing (oSDB) in children often requires surgical intervention.
  • Tonsillectomy/adenoidectomy (T/A) is a common treatment, but outcomes can be improved.
  • Turbinate hypertrophy is a contributing factor in pediatric oSDB.

Purpose of the Study:

  • To assess the utility and cost-effectiveness of adding bilateral inferior turbinoplasty to T/A for pediatric oSDB.
  • To determine the impact of turbinoplasty on quality-adjusted life years (QALYs) and overall treatment utility.
  • To identify key variables influencing the decision through sensitivity analysis.

Main Methods:

  • A cost-utility decision analysis model was developed using hypothetical cohorts.
  • Data from published literature and Centers for Medicare and Medicaid databases were utilized.
  • Sensitivity analyses were performed to evaluate the impact of key parameters on model outcomes.

Main Results:

  • The baseline model favored adding turbinoplasty to T/A, showing higher overall utility (0.8890 vs 0.8875).
  • Sensitivity analysis identified treatment success increase as the critical factor; a 3% improvement favored concurrent turbinoplasty.
  • The incremental cost-effectiveness ratio (ICER) was $27,333/QALY, below the willingness-to-pay threshold.

Conclusions:

  • Adding bilateral inferior turbinoplasty to T/A is beneficial for children with turbinate hypertrophy and pediatric oSDB.
  • The combined procedure demonstrates favorable utility gains and cost-benefit advantages.
  • Even modest benefits from turbinoplasty support its addition to T/A for improved pediatric oSDB treatment.
Abstract

Keywords:
cost-effective analysisdecision analysisincremental cost-effectiveness ratiopediatric sleep-disordered breathingturbinoplasty

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