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 €1385 (US $1995) and €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. TRIAL REGISTRATION trialregister.nl Identifier:NTR968; isrctn.org Identifier:ISRCTN03720485.