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. 2021 Mar;46(2):347-356.
doi: 10.1111/coa.13675. Epub 2020 Dec 13.

Changes in healthcare utilisation for paediatric tonsillectomy and adenoidectomy in the Netherlands: a population-based study

Juliëtte J C M van Munster  1   2 , Amir H Zamanipoor Najafabadi  2 , Janneke van 't Hooft  3 , Teus A van Barneveld  4 , Stefan Böhringer  5 , Jorrit S Visser  6 , Rolf H Bremmer  6 , Wilco C Peul  2 , Wilbert B van den Hout  5 , Peter Paul G van Benthem  1
Affiliations

Changes in healthcare utilisation for paediatric tonsillectomy and adenoidectomy in the Netherlands: a population-based study

Juliëtte J C M van Munster et al. Clin Otolaryngol. 2021 Mar.

Abstract

Objectives: Tonsillectomy and adenoidectomy in children are controversial subjects with large regional variation in surgical rates, partly explained by cultural differences and lack of high-quality evidence on indications for surgery. A quality of care cycle was executed on this topic in the Netherlands. The objective of this study was to estimate changes in healthcare utilisation for paediatric tonsil surgery in the Netherlands.

Methods: Population-based data on tonsillectomies and adenoidectomies in children up to age 10 were retrieved retrospectively from Dutch administrative databases between 2005 and 2018. A change point analysis was performed to detect the most pivotal change point in surgical rates. We performed univariate analyses to compare surgical patients' characteristics before and after the pivotalpoint . Impact on healthcare budget and societal costs were estimated using current prices and data from cost-effectiveness analyses.

Results: The annual number of adenotonsillectomies reduced by 10 952 procedures (-39%; from 129 per 10 000 children to 87 per 10 000 children) between 2005 and 2018, and the number of adenoidectomies by 14 757 procedures (-49%; from 138 per 10 000 children to 78 per 10 000 children). The most pivotal change point was observed around 2012, accompanied by small changes in patient selection for surgery before and after 2012. An estimated €5.3 million per year was saved on the healthcare budget and €10.4 million per year on societal costs.

Conclusion: The quality of care cycle resulted in fewer operations, with a concomitant reduction of costs. We suggest that part of these savings be invested in new research to maintain the quality of care cycle.

Keywords: changes; children; costs; evidence-based medicine; surgery; trends.

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Conflict of interest statement

All authors declare no competing interests.

Figures

Figure 1
Figure 1
The quality of care cycle on the effectiveness of adenotonsillectomy and adenoidectomy in children
Figure 2
Figure 2
A, Absolute number of adenotonsillectomies in children age 0‐10 years in the Netherlands between 2005 and 2018. B, Absolute number of adenoidectomies in children age 0‐10 years in the Netherlands between 2005 and 2018
Figure 3
Figure 3
In‐hospital surgical rates for adenotonsillectomies and adenoidectomies in children age 0‐10 years in the Netherlands between 2005 and 2018.
Figure 4
Figure 4
A, Number of adenotonsillectomies per 10 000 children age 0‐10 years in the Netherlands between 2005 and 2018. B, Number of adenoidectomies per 10 000 children age 0‐10 years in the Netherlands between 2005 and 2018
Figure A1
Figure A1
Comparison between the Dutch Healthcare Authority database and the LOGEX database on numbers of adenotonsillectomies and adenoidectomies
Figure A2
Figure A2
Adenotonsillectomy and adenoidectomy in children aged 11‐15 years
See this image and copyright information in PMC

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