gms | German Medical Science

Introduction: Acute tonsillitis is a common disease, which affects 120000 people in Germany every year [1]. Even with treatment, it can turn into a peritonsillar abscess as a complication [2]. The usual treatment option for acute tonsillitis is conservative, meaning giving either supportive medication or, in the case of a bacterial infection, antibiotics. A frequent use of antibiotics may increase bacterial resistance, especially when repeatedly applied in the case of recurring acute tonsillitis [3].

Another treatment option is tonsillectomy, in which the tonsils are surgically removed to prevent recurrence of tonsillitis. However, such surgery is more costly than conservative treatment and is associated with complications such as bleeding.

Objective: The aim of this analysis was to find out at how many episodes of acute tonsillitis (ATI) surgery is more cost effective than conservative treatment from a health economic perspective.

Methods: To investigate when surgical treatment is more cost-effective, a health-economic Markov model was constructed from the perspective of a tertiary care provider in the German Statutory Health Care System, assuming that the patient undergoes surgery after different episodes of repeated diagnosis of acute tonsillitis (2, 3, 4 and 8 episodes, respectively). The model takes into account both reoperations and specific mortality based on scientific published data. Reimbursement figures were provided by the university clinic Mainz. Key outcome parameters were the health-related quality of life [4] as well as the Net Monetary Benefit (NMB) against a threshold ICUR of 23500 €/QALY gained [5] respectively.

Results: Medical outcomes in terms of patient quality of life within 1 year differed between the extreme scenarios with 2 ATIs to surgery and with 8 ATIs to surgery by 0,00348. The difference of the cost results after 4 episodes of ATI would be reduced and could fall in the ambiguous noise range (+3,61 €). However, the additional cost of the early surgical decision was also very low after 3 ATIs (+49,94 €) or 2 ATIs (+646,93 €). Furthermore, in the tornado diagram, it could be seen that the high cost of surgery had a significant impact on the outcome. In terms of cost-effectiveness, arithmetically, the scenario of delaying surgery as long as possible predominated over the other options. However, the medical and economic outcomes were very close and the differences were so small that the health economic outcomes are not relevant.

Conclusion: This study suggests that doctors and patients do not need to consider financial aspects of their clinical decision after three conservative treatment attempts at the latest. The personal situation should be decisive for the therapy decision in patients with acute tonsillitis. Due to the current lack of comparison possibilities, a future model validation based on external research results is desired.

The authors declare that they have no competing interests.

The authors declare that an ethics committee vote is not required.