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

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 Netherla...

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Published in:	Clinical otolaryngology Vol. 46; no. 2; pp. 347 - 356
Main Authors:	Munster, Juliëtte J. C. M., Zamanipoor Najafabadi, Amir H., Hooft, Janneke, Barneveld, Teus A., Böhringer, Stefan, Visser, Jorrit S., Bremmer, Rolf H., Peul, Wilco C., den Hout, Wilbert B., Benthem, Peter Paul G.
Format:	Journal Article
Language:	English
Published:	England Wiley Subscription Services, Inc 01-03-2021 John Wiley and Sons Inc
Subjects:	Budgets changes Children Cost analysis Cost control Costs Cultural factors evidence‐based medicine Health care Health services utilization Original Pediatrics Population studies Population-based studies Surgery Tonsil trends Netherlands changes costs children evidence-based medicine trends surgery
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Summary:	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.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1749-4478 1749-4486
DOI:	10.1111/coa.13675