Cost Benefit and Utility Decision Analysis of Turbinoplasty with Adenotonsillectomy for Pediatric Sleep-Disordered Breathing.
Otolaryngol Head Neck Surg
; 161(2): 343-347, 2019 08.
Article
em En
| MEDLINE
| ID: mdl-31010383
ABSTRACT
OBJECTIVES:
Use decision analysis techniques to assess the potential utility gains/losses and costs of adding bilateral inferior turbinoplasty to tonsillectomy/adenoidectomy (T/A) for the treatment of obstructive sleep-disordered breathing (oSDB) in children. Use sensitivity analysis to explore the key variables in the scenario. STUDYDESIGN:
Cost-utility decision analysis model.SETTING:
Hypothetical cohort. SUBJECTS ANDMETHODS:
Computer software (TreeAge Software, Williamstown, Massachusetts) was used to construct a decision analysis model. The model included the possibility of postoperative complications and persistent oSDB after surgery. Baseline clinical and quality-adjusted life year (QALY) parameters were estimated using published data. Cost data were estimated from Centers for Medicare and Medicaid 2018 databases ( www.cms.gov ). Sensitivity analyses were completed to assess for key model parameters.RESULTS:
The utility analysis of the baseline model favored the addition of turbinoplasty (0.8890 vs 0.8875 overall utility) assuming turbinate hypertrophy was present. Sensitivity analysis indicated the treatment success increase (%) provided by concurrent turbinoplasty was the key parameter in the model. A treatment success increase of 3% of turbinoplasty was the threshold where concurrent turbinoplasty was favored over T/A alone. The incremental cost-effectiveness ratio (ICER) of $27,333/QALY for the baseline model was favorable to the willingness-to-pay threshold of $50,000 to $100,000/QALY for industrialized nations.CONCLUSIONS:
The addition of turbinoplasty for children with turbinate hypertrophy to T/A for the treatment of pediatric oSDB is beneficial from both a utility and cost-benefit analysis standpoint even if the benefits of turbinoplasty are relatively modest.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Síndromes da Apneia do Sono
/
Tonsilectomia
/
Conchas Nasais
/
Adenoidectomia
/
Técnicas de Apoio para a Decisão
/
Análise Custo-Benefício
Tipo de estudo:
Health_economic_evaluation
/
Prognostic_studies
Limite:
Child
/
Humans
Idioma:
En
Ano de publicação:
2019
Tipo de documento:
Article