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Open Access 01-03-2020

The cost-effectiveness analysis of drug therapy versus surgery for symptomatic adenoid hypertrophy by a Markov model

Authors: Han Xiao, Jinqiang Huang, Weifeng Liu, Zihao Dai, Sui Peng, Zhenwei Peng, Ruiming Liang, Renqiang Ma, Yihui Wen, Jian Li, Weiping Wen

Published in: Quality of Life Research | Issue 3/2020

Abstract

Purpose

Adenoid hypertrophy (AH) is common among young children. Adenoid-based surgery and drug therapy could be applied for symptomatic AH patients, yet the treatment decision is difficult to make due to the diverse cost and efficacy between these two treatments.

Methods

A Markov simulation model was designed to estimate the cost-effectiveness (CE) of the adenoid-based surgery and the drug therapy for symptomatic AH patients. Transition probabilities, costs and utilities were extracted from early researches and expert opinions. Simulations using two set of parameter inputs for China and the USA were performed. Primary outcome was cost per QALY gained over a 6-year period. Deterministic and probabilistic sensitivity analyses were also conducted.

Results

The utility for the surgery group and the drug group were 4.10 quality-adjusted life years (QALYs) and 3.58 QALYs, respectively. The cost of the surgery group was more than that of the drug group using model parameters specific to China ($1069.0 vs. $753.7) but was less for the USA ($1994.4 vs. $3977.7). Surgery was dominant over drug therapy when US specific parameters were used. Surgery group had an ICER of $604.0 per QALY when parameters specific to China was used.

Conclusion

Surgery is cost-effective in the simulations for both China and the USA at WTP thresholds of $9633.1 and $62,517.5, respectively.

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Marseglia, G. L., Caimmi, D., Pagella, F., Matti, E., Labo, E., Licari, A., et al. (2011). Adenoids during childhood: The facts. International Journal of Immunopathology and Pharmacology,24(4 Suppl), 1–5. https://doi.org/10.1177/03946320110240S401.CrossRefPubMed

Gerhardsson, H., Stalfors, J., Odhagen, E., & Sunnergren, O. (2016). Pediatric adenoid surgery in Sweden 2004–2013: Incidence, indications and concomitant surgical procedures. International Journal of Pediatric Otorhinolaryngology,87, 61–66. https://doi.org/10.1016/j.ijporl.2016.05.020.CrossRefPubMed

Shokouhi, F., Meymaneh Jahromi, A., Majidi, M. R., & Salehi, M. (2015). Montelukast in adenoid hypertrophy: Its effect on size and symptoms. Iranian Journal of Otorhinolaryngology,27(83), 443–448.PubMedPubMedCentral

Meng, W., Zhou, W., Li, G., Zhagn, Q., Li, G., Zhou, H., et al. (2014). The analysis of surgery effect of OSAHS children accompanied with sinusitis. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi,28(7), 462–464.PubMed

Bhargava, R., & Chakravarti, A. (2014). A double-blind randomized placebo-controlled trial of topical intranasal mometasone furoate nasal spray in children of adenoidal hypertrophy with otitis media with effusion. American Journal of Otolaryngology,35(6), 766–770. https://doi.org/10.1016/j.amjoto.2014.06.006.CrossRefPubMed

Bhargava, R., & Chakravarti, A. (2014). Role of mometasone furoate aqueous nasal spray for management of adenoidal hypertrophy in children. Journal of Laryngology and Otology,128(12), 1060–1066. https://doi.org/10.1017/S0022215114002503.CrossRefPubMed

Chohan, A., Lal, A., Chohan, K., Chakravarti, A., & Gomber, S. (2015). Systematic review and meta-analysis of randomized controlled trials on the role of mometasone in adenoid hypertrophy in children. International Journal of Pediatric Otorhinolaryngology,79(10), 1599–1608. https://doi.org/10.1016/j.ijporl.2015.07.009.CrossRefPubMed

Colavita, L., Miraglia Del Giudice, M., Stroscio, G., Visalli, C., Alterio, T., Pidone, C., et al. (2015). Allergic rhinitis and adenoid hypertrophy in children: Is adenoidectomy always really useful? Journal of Biological Regulators and Homeostatic Agents,29(2 Suppl 1), 58–63.PubMed

Chadha, N. K., Zhang, L., Mendoza-Sassi, R. A., & Cesar, J. A. (2009). Using nasal steroids to treat nasal obstruction caused by adenoid hypertrophy: Does it work? Otolaryngology,140(2), 139–147. https://doi.org/10.1016/j.otohns.2008.11.008.CrossRef

10.

Torrance, G. W., Drummond, M. F., Sculpher, M. J., Claxton, K., & Stoddart, G. L. (2005). Methods for the economic evaluation of health care programmes. Oxford: Oxford University Press.

11.

Briggs, A., & Sculpher, M. (1998). An introduction to Markov modelling for economic evaluation. Pharmacoeconomics,13(4), 397–409. https://doi.org/10.2165/00019053-199813040-00003.CrossRefPubMed

12.

Parsonnet, J., Harris, R. A., Hack, H. M., & Owens, D. K. (1996). Modelling cost-effectiveness of Helicobacter pylori screening to prevent gastric cancer: A mandate for clinical trials. The Lancet,348(9021), 150–154.CrossRef

13.

Nayagam, S., Conteh, L., Sicuri, E., Shimakawa, Y., Suso, P., Tamba, S., et al. (2016). Cost-effectiveness of community-based screening and treatment for chronic hepatitis B in The Gambia: An economic modelling analysis. The Lancet Global Health,4(8), e568–578. https://doi.org/10.1016/S2214-109X(16)30101-2.CrossRefPubMed

14.

Hillner, B. E., & Smith, T. J. (1991). Efficacy and cost effectiveness of adjuvant chemotherapy in women with node-negative breast cancer. A decision-analysis model. The New England Journal of Medicine,324(3), 160–168. https://doi.org/10.1056/nejm199101173240305.CrossRefPubMed

15.

Onal, M., Yilmaz, T., Bilgic, E., Muftuoglu, S., Sozen, T., & Bajin, M. D. (2015). Possible role of apoptosis in pathogenesis of adenoid hypertrophy and chronic adenoiditis: Prospective case–control study. Auris, Nasus, Larynx,42(6), 449–452. https://doi.org/10.1016/j.anl.2015.04.012.CrossRefPubMed

16.

Adedeji, T. O., Amusa, Y. B., & Aremu, A. A. (2016). Correlation between adenoidal nasopharyngeal ratio and symptoms of enlarged adenoids in children with adenoidal hypertrophy. African Journal of Paediatric Surgery,13(1), 14–19. https://doi.org/10.4103/0189-6725.181701.CrossRefPubMed

17.

Berlucchi, M., Salsi, D., Valetti, L., Parrinello, G., & Nicolai, P. (2007). The role of mometasone furoate aqueous nasal spray in the treatment of adenoidal hypertrophy in the pediatric age group: Preliminary results of a prospective, randomized study. Pediatrics,119(6), e1392–1397. https://doi.org/10.1542/peds.2006-1769.CrossRefPubMed

18.

Capaccio, P., Torretta, S., Marciante, G. A., Marchisio, P., Forti, S., & Pignataro, L. (2016). Endoscopic adenoidectomy in children with otitis media with effusion and mild hearing loss. Clinical and Experimental Otorhinolaryngology,9(1), 33–38. https://doi.org/10.21053/ceo.2016.9.1.33.CrossRefPubMedPubMedCentral

19.

Takahashi, H., Honjo, I., Fujita, A., & Kurata, K. (1997). Effects of adenoidectomy on sinusitis. Acta Oto-Rhino-Laryngologica Belgica,51(2), 85–87.CrossRef

20.

Dempster, J. H., Browning, G. G., & Gatehouse, S. G. (1993). A randomized study of the surgical management of children with persistent otitis media with effusion associated with a hearing impairment. Journal of Laryngology and Otology,107(4), 284–289.CrossRef

21.

Ramadan, H. H. (1999). Adenoidectomy vs endoscopic sinus surgery for the treatment of pediatric sinusitis. Archives of Otolaryngology,125(11), 1208–1211.CrossRef

22.

Ramadan, H. H., & Terrell, A. M. (2010). Balloon catheter sinuplasty and adenoidectomy in children with chronic rhinosinusitis. Annals of Otology, Rhinology, and Laryngology,119(9), 578–582.CrossRef

23.

Ramadan, H. H., & Makary, C. A. (2014). Can computed tomography score predict outcome of adenoidectomy for chronic rhinosinusitis in children. American Journal of Rhinology & Allergy,28(1), e80–82. https://doi.org/10.2500/ajra.2014.28.4004.CrossRef

24.

Kubba, H., & Bingham, B. J. (2001). Can nasal endoscopy be used to predict residual symptoms after adenoidectomy for nasal obstruction? International Journal of Pediatric Otorhinolaryngology,58(3), 223–228.CrossRef

25.

Yu, C., Cai, X., Wen, Z., Liang, D., Hu, Q., Ni, L., et al. (2015). A comparative study on efficiency of different therapeutics methods used for obstructive sleep apnea hypopnea syndrome in children. Zhonghua Er Ke Za Zhi,53(3), 172–177.PubMed

26.

Bahadir, O., Caylan, R., Bektas, D., & Bahadir, A. (2006). Effects of adenoidectomy in children with symptoms of adenoidal hypertrophy. European Archives of Oto-Rhino-Laryngology,263(2), 156–159. https://doi.org/10.1007/s00405-005-0962-x.CrossRefPubMed

27.

Jonas, N. E., Sayed, R., & Prescott, C. A. (2007). Prospective, randomized, single-blind, controlled study to compare two methods of performing adenoidectomy. International Journal of Pediatric Otorhinolaryngology,71(10), 1555–1562. https://doi.org/10.1016/j.ijporl.2007.06.008.CrossRefPubMed

28.

Group, M. R. C. M. O. M. S. (2012). Adjuvant adenoidectomy in persistent bilateral otitis media with effusion: hearing and revision surgery outcomes through 2 years in the TARGET randomised trial. Clinical Otolaryngology,37(2), 107–116. https://doi.org/10.1111/j.1749-4486.2012.02469.x.CrossRef

29.

Maw, A. R., & Parker, A. J. (1993). A model to refine the selection of children with otitis media with effusion for adenoidectomy. Clinical Otolaryngology & Allied Sciences,18(3), 164–170.CrossRef

30.

Skilbeck, C. J., Tweedie, D. J., Lloyd-Thomas, A. R., & Albert, D. M. (2007). Suction diathermy for adenoidectomy: Complications and risk of recurrence. International Journal of Pediatric Otorhinolaryngology,71(6), 917–920. https://doi.org/10.1016/j.ijporl.2007.03.001.CrossRefPubMed

31.

Grindle, C. R., Murray, R. C., Chennupati, S. K., Barth, P. C., & Reilly, J. S. (2011). Incidence of revision adenoidectomy in children. Laryngoscope,121(10), 2128–2130. https://doi.org/10.1002/lary.22161.CrossRefPubMed

32.

Perkins, J. N., Liang, C., Gao, D., Shultz, L., & Friedman, N. R. (2012). Risk of post-tonsillectomy hemorrhage by clinical diagnosis. Laryngoscope,122(10), 2311–2315. https://doi.org/10.1002/lary.23421.CrossRefPubMed

33.

Vlastos, I. M., Athanasopoulos, I., Economides, J., Parpounas, K., & Houlakis, M. (2010). Outpatient cold knife tonsillectomy in toddlers with sleep disordered breathing. B-ENT,6(4), 245–250.PubMed

34.

del Rio Camacho, G., Martinez Gonzalez, M., Sanabria Brossart, J., Gutierrez Moreno, E., Gomez Garcia, T., & Troncoso Acevedo, F. (2014). Post-operative complications following adenotonsillectomy in children with severe sleep apnea-hypopnea syndrome. Do they need to be admitted to an intensive care unit? Acta Otorrinolaringol Esp,65(5), 302–307. https://doi.org/10.1016/j.otorri.2014.03.004.CrossRef

35.

Berlucchi, M., Valetti, L., Parrinello, G., & Nicolai, P. (2008). Long-term follow-up of children undergoing topical intranasal steroid therapy for adenoidal hypertrophy. International Journal of Pediatric Otorhinolaryngology,72(8), 1171–1175. https://doi.org/10.1016/j.ijporl.2008.04.001.CrossRefPubMed

36.

Kheirandish-Gozal, L., Bhattacharjee, R., Bandla, H. P. R., & Gozal, D. (2014). Antiinflammatory therapy outcomes for mild OSA in children. Chest,146(1), 88–95. https://doi.org/10.1378/chest.13-2288.CrossRefPubMedPubMedCentral

37.

Goldbart, A. D., Greenberg-Dotan, S., & Tal, A. (2012). Montelukast for children with obstructive sleep apnea: A double-blind, placebo-controlled study. Pediatrics,130(3), e575–580. https://doi.org/10.1542/peds.2012-0310.CrossRefPubMed

38.

Qing-Long, G. U., Gao, F., & Pang, C. (2009). The effect of fluticasone propionate nasal spray on pediatric adenoidal hypertrophy. Beijing Medical Journal.

39.

China, N. B. o. S. o. (2019). SDDS Real Sector: Time Series Data. Retrieved from http://www.stats.gov.cn/english/Statisticaldata/nsdp/201508/t20150831_1238096.html.

40.

Labor, U. S. D. o. (2019). Consumer Price Index. Retrieved from https://www.bls.gov/cpi/tables/home.htm.

41.

Meier, J. D., Zhang, Y., Greene, T. H., Curtis, J. L., & Srivastava, R. (2015). Variation in pediatric outpatient adenotonsillectomy costs in a multihospital network. Laryngoscope,125(5), 1215–1220. https://doi.org/10.1002/lary.24981.CrossRefPubMed

42.

Boonacker, C. W., van den Aardweg, M. T., Broos, P. H., Hoes, A. W., Schilder, A. G., & Rovers, M. M. (2013). Immediate adenoidectomy vs initial watchful waiting strategy in children with recurrent upper respiratory tract infections: An economic evaluation. JAMA Otolaryngology–Head & Neck Surgery,139(2), 129–133. https://doi.org/10.1001/jamaoto.2013.1324.CrossRef

43.

Meier, J. D., Duval, M., Wilkes, J., Andrews, S., Korgenski, E. K., Park, A. H., et al. (2014). Surgeon dependent variation in adenotonsillectomy costs in children. Otolaryngology - Head and Neck Surgery,150(5), 887–892. https://doi.org/10.1177/0194599814522758.CrossRefPubMed

44.

Curtis, J. L., Harvey, D. B., Willie, S., Narasimhan, E., Andrews, S., Henrichsen, J., et al. (2015). Causes and costs for ED visits after pediatric adenotonsillectomy. Otolaryngology–Head and Neck Surgery,152(4), 691–696. https://doi.org/10.1177/0194599815572123.CrossRefPubMed

45.

Nazer, R. I., Alburikan, K. A., Ullah, A., Albarrati, A. M., & Hassanain, M. (2018). Transient liver dysfunction increases surgical site infections after coronary surgery. Asian Cardiovascular & Thoracic Annals,26(6), 439–445. https://doi.org/10.1177/0218492318793305.CrossRef

46.

Tousignant, P., Cosio, M. G., Levy, R. D., & Groome, P. A. (1994). Quality adjusted life years added by treatment of obstructive sleep apnea. Sleep,17(1), 52–60.PubMed

47.

Rizzi, C. F., Ferraz, M. B., Poyares, D., & Tufik, S. (2014). Quality-adjusted life-years gain and health status in patients with OSAS after one year of continuous positive airway pressure use. Sleep,37(12), 1963–1968. https://doi.org/10.5665/sleep.4250.CrossRefPubMedPubMedCentral

48.

Remenschneider, A. K., Scangas, G., Meier, J. C., Gray, S. T., Holbrook, E. H., Gliklich, R. E., et al. (2015). EQ-5D-derived health utility values in patients undergoing surgery for chronic rhinosinusitis. Laryngoscope,125(5), 1056–1061. https://doi.org/10.1002/lary.25054.CrossRefPubMed

49.

Adappa, N. D., & Coticchia, J. M. (2006). Management of refractory chronic rhinosinusitis in children. American Journal of Otolaryngology,27(6), 384–389. https://doi.org/10.1016/j.amjoto.2006.03.003.CrossRefPubMed

50.

Rudmik, L., Soler, Z. M., Mace, J. C., Schlosser, R. J., & Smith, T. L. (2015). Economic evaluation of endoscopic sinus surgery versus continued medical therapy for refractory chronic rhinosinusitis. Laryngoscope,125(1), 25–32. https://doi.org/10.1002/lary.24916.CrossRefPubMed

51.

Williamson, I., Benge, S., Barton, S., Petrou, S., Letley, L., Fasey, N., et al. (2009). A double-blind randomised placebo-controlled trial of topical intranasal corticosteroids in 4- to 11-year-old children with persistent bilateral otitis media with effusion in primary care. Health Technology Assessment,13(37), 1–144. https://doi.org/10.3310/hta13370.CrossRefPubMed

52.

Escarra, F., & Vidaurreta, S. M. (2015). Assessment of quality of life before and after an adenotonsillectomy among children with hypertrophic tonsils and/or adenoids. Arch Argent Pediatr,113(1), 21–27. https://doi.org/10.1590/s0325-00752015000100005.CrossRefPubMed

53.

Fund, I. M. (2018). World Economic and Financial Surveys-World Economic Outlook Database. Retrieved November 11, from, 2019 https://www.imf.org/external/pubs/ft/weo/2018/02/weodata/index.aspx.

54.

Thomas, K., Boeger, D., Buentzel, J., Esser, D., Hoffmann, K., Jecker, P., et al. (2013). Pediatric adenoidectomy: A population-based regional study on epidemiology and outcome. International Journal of Pediatric Otorhinolaryngology,77(10), 1716–1720. https://doi.org/10.1016/j.ijporl.2013.07.032.CrossRefPubMed

55.

Kar, M., Altintoprak, N., Muluk, N. B., Ulusoy, S., Bafaqeeh, S. A., & Cingi, C. (2016). Antileukotrienes in adenotonsillar hypertrophy: A review of the literature. European Archives of Oto-Rhino-Laryngology,273(12), 4111–4117. https://doi.org/10.1007/s00405-016-3983-8.CrossRefPubMed

56.

Kuhle, S., & Urschitz, M. S. (2011). Anti-inflammatory medications for obstructive sleep apnea in children. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.cd007074.pub2.CrossRefPubMed

57.

Rajeshwary, A., Rai, S., Somayaji, G., & Pai, V. (2013). Bacteriology of symptomatic adenoids in children. North American Journal of Medicine & Science,5(2), 113–118. https://doi.org/10.4103/1947-2714.107529.CrossRef

58.

Gunel, C., Kirdar, S., Omurlu, I. K., & Agdas, F. (2015). Detection of the Epstein-Barr virus, Human Bocavirus and novel KI and KU polyomaviruses in adenotonsillar tissues. International Journal of Pediatric Otorhinolaryngology,79(3), 423–427. https://doi.org/10.1016/j.ijporl.2015.01.007.CrossRefPubMed

59.

Tagayaab, M., Yasuma, F., Miyazaki, S., Sasaki, F., Morinaga, M., Suzuki, K., et al. (2012). Relationship between adenoid size and severity of obstructive sleep apnea in preschool children. International Journal of Pediatric Otorhinolaryngology,76(12), 1827–1830.CrossRef

60.

Hwang, S. H., Guilleminault, C., Park, C. S., Kim, T. W., & Hong, S. C. (2013). Usefulness of adenotonsillar size for prediction of severity of obstructive sleep apnea and flow limitation. Otolaryngology,149(2), 326–334. https://doi.org/10.1177/0194599813490892.CrossRef

61.

van den Aardweg, M. T., Rovers, M. M., Kraal, A., & Schilder, A. G. (2010). Current indications for adenoidectomy in a sample of children in the Netherlands. B-ENT,6(1), 15–18.PubMed

62.

Kim, S. Y., Lee, W. H., Rhee, C. S., Lee, C. H., & Kim, J. W. (2013). Regrowth of the adenoids after coblation adenoidectomy: cephalometric analysis. Laryngoscope,123(10), 2567–2572. https://doi.org/10.1002/lary.23984.CrossRefPubMed

Title: The cost-effectiveness analysis of drug therapy versus surgery for symptomatic adenoid hypertrophy by a Markov model
Authors: Han Xiao
Jinqiang Huang
Weifeng Liu
Zihao Dai
Sui Peng
Zhenwei Peng
Ruiming Liang
Renqiang Ma
Yihui Wen
Jian Li
Weiping Wen
Publication date: 01-03-2020
Publisher: Springer International Publishing
Published in: Quality of Life Research / Issue 3/2020
Print ISSN: 0962-9343
Electronic ISSN: 1573-2649
DOI: https://doi.org/10.1007/s11136-019-02374-8

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

The cost-effectiveness analysis of drug therapy versus surgery for symptomatic adenoid hypertrophy by a Markov model

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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