Immediate adenoidectomy vs initial watchful waiting strategy in children with recurrent upper respiratory tract infections: an economic evaluation

Abstract

Objective: To compare the costs associated with 2 clinical strategies in children with recurrent upper respiratory tract infections (URTIs): immediate adenoidectomy vs an initial watchful waiting strategy.

Design: A cost-minimization analysis from a societal perspective including both direct and indirect costs, alongside an open randomized controlled trial with a 2-year follow-up.

Setting: Multicenter study, including 11 general and 2 university hospitals in the Netherlands.

Patients: The study population comprised 111 children aged 1 through 6 years, selected for adenoidectomy for recurrent URTIs according to current clinical practice.

Intervention: A strategy of immediate adenoidectomy with or without myringotomy or a strategy of initial watchful waiting.

Main outcomes measures: Difference in median costs during the 2-year follow-up.

Results: The median total of direct and indirect costs in the adenoidectomy and watchful waiting group were €1385 (US $1995) and €844 (US $1216) per patient, respectively. The extra costs in the adenoidectomy group are primarily attributable to surgery and visits to the otorhinolaryngologist. Other costs did not differ significantly between the groups.

Conclusions: In children selected for adenoidectomy for recurrent URTIs, immediate adenoidectomy results in an increase in costs, whereas it confers no clinical benefit over an initial watchful waiting strategy.

Trial registration: trialregister.nl Identifier:NTR968; isrctn.org Identifier:ISRCTN03720485.