Immediate Adenoidectomy vs Initial Watchful Waiting Strategy in Children With Recurrent Upper Respiratory Tract Infections An Economic Evaluation

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 (sic)1385 (US $1995) and (sic)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.