Antibiotics or Tonsillectomy for Adult Recurrent Tonsillitis : Analyzing the Lesser of Two Evils
© 2023 The Authors. The Laryngoscope published by Wiley Periodicals LLC on behalf of The American Laryngological, Rhinological and Otological Society, Inc..
OBJECTIVE: To determine the best timing for surgical intervention for adults with recurrent tonsillitis (RT).
METHODS: A Markov model was constructed using variables and ranges based upon a literature review. A 1-way sensitivity analysis was performed to evaluate the number of yearly bouts at which each algorithm (antibiotics or tonsillectomy) would be favored. A Monte-Carlo probabilistic sensitivity analysis was calculated for gains and cost. Model outcomes were measured with quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICER) for tonsillectomy versus repeat antibiotic treatment.
RESULTS: Patients expected to sustain a single annual tonsillitis event will have a negative QALY of 0.02 if treated with surgery and those with 2 annual events will have a QALY gain from undergoing tonsillectomy of 0.01, 3 events = 0.03, 4 events = 0.05, 5 events = 0.07, 6 events = 0.09, 7 events = 0.1, and 8 events = 0.11. These gains became meaningful only after 2 years of recurrent bouts. The average cost of tonsillectomy was 3,238 USD, and the overall average cost of RT was 7,069 USD (an incremental cost of 3,831 USD). The ICER of tonsillectomy over antibiotic treatment for 1 QALY gain was 44,741 USD.
CONCLUSION: Adult patients who sustain more than 3 annual bouts of tonsillitis over a period of at least 2 years will gain QALY after tonsillectomy. These gains increase proportionally to the number of yearly events and perennial episodes. The incremental costs of tonsillectomy fail to meet the NICE guidelines but are within other acceptable reference ranges.
LEVEL OF EVIDENCE: NA Laryngoscope, 134:2153-2161, 2024.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2024 |
|---|---|
| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:134 |
|---|---|
| Enthalten in: |
The Laryngoscope - 134(2024), 5 vom: 08. Apr., Seite 2153-2161 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Jacob, Tommy [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
Anti-Bacterial Agents |
|---|
| Anmerkungen: |
Date Completed 11.04.2024 Date Revised 11.04.2024 published: Print-Electronic Citation Status MEDLINE |
|---|
| doi: |
10.1002/lary.31139 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM364295686 |
|---|
| LEADER | 01000caa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM364295686 | ||
| 003 | DE-627 | ||
| 005 | 20240411232140.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 231226s2024 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1002/lary.31139 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1372.xml |
| 035 | |a (DE-627)NLM364295686 | ||
| 035 | |a (NLM)37937815 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Jacob, Tommy |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Antibiotics or Tonsillectomy for Adult Recurrent Tonsillitis |b Analyzing the Lesser of Two Evils |
| 264 | 1 | |c 2024 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 11.04.2024 | ||
| 500 | |a Date Revised 11.04.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2023 The Authors. The Laryngoscope published by Wiley Periodicals LLC on behalf of The American Laryngological, Rhinological and Otological Society, Inc. | ||
| 520 | |a OBJECTIVE: To determine the best timing for surgical intervention for adults with recurrent tonsillitis (RT) | ||
| 520 | |a METHODS: A Markov model was constructed using variables and ranges based upon a literature review. A 1-way sensitivity analysis was performed to evaluate the number of yearly bouts at which each algorithm (antibiotics or tonsillectomy) would be favored. A Monte-Carlo probabilistic sensitivity analysis was calculated for gains and cost. Model outcomes were measured with quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICER) for tonsillectomy versus repeat antibiotic treatment | ||
| 520 | |a RESULTS: Patients expected to sustain a single annual tonsillitis event will have a negative QALY of 0.02 if treated with surgery and those with 2 annual events will have a QALY gain from undergoing tonsillectomy of 0.01, 3 events = 0.03, 4 events = 0.05, 5 events = 0.07, 6 events = 0.09, 7 events = 0.1, and 8 events = 0.11. These gains became meaningful only after 2 years of recurrent bouts. The average cost of tonsillectomy was 3,238 USD, and the overall average cost of RT was 7,069 USD (an incremental cost of 3,831 USD). The ICER of tonsillectomy over antibiotic treatment for 1 QALY gain was 44,741 USD | ||
| 520 | |a CONCLUSION: Adult patients who sustain more than 3 annual bouts of tonsillitis over a period of at least 2 years will gain QALY after tonsillectomy. These gains increase proportionally to the number of yearly events and perennial episodes. The incremental costs of tonsillectomy fail to meet the NICE guidelines but are within other acceptable reference ranges | ||
| 520 | |a LEVEL OF EVIDENCE: NA Laryngoscope, 134:2153-2161, 2024 | ||
| 650 | 4 | |a Review | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a antibiotics | |
| 650 | 4 | |a complications | |
| 650 | 4 | |a model | |
| 650 | 4 | |a recurrent tonsillitis (RT) | |
| 650 | 4 | |a tonsillectomy | |
| 650 | 7 | |a Anti-Bacterial Agents |2 NLM | |
| 700 | 1 | |a Leshno, Moshe |e verfasserin |4 aut | |
| 700 | 1 | |a Carmel-Neidermann, Narin Nard |e verfasserin |4 aut | |
| 700 | 1 | |a Kampel, Liyona |e verfasserin |4 aut | |
| 700 | 1 | |a Warshavsky, Anton |e verfasserin |4 aut | |
| 700 | 1 | |a Mansour, Joubran |e verfasserin |4 aut | |
| 700 | 1 | |a Assadi, Nidal |e verfasserin |4 aut | |
| 700 | 1 | |a Muhanna, Nidal |e verfasserin |4 aut | |
| 700 | 1 | |a Horowitz, Gilad |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t The Laryngoscope |d 1945 |g 134(2024), 5 vom: 08. Apr., Seite 2153-2161 |w (DE-627)NLM000205370 |x 1531-4995 |7 nnns |
| 773 | 1 | 8 | |g volume:134 |g year:2024 |g number:5 |g day:08 |g month:04 |g pages:2153-2161 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1002/lary.31139 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 134 |j 2024 |e 5 |b 08 |c 04 |h 2153-2161 | ||