A cost-effectiveness analysis of coagulation testing prior to tonsillectomy and adenoidectomy in children.
BACKGROUND
The American Society of Pediatric Otolaryngology recommends pre-operative coagulation testing only when indicated by history or physical exam. Nevertheless, many surgeons test all children scheduled for tonsillectomy and/or adenoidectomy (T&A). Studies of pre-operative screening have had conflicting results. A decision analysis model was constructed to address the costs and health outcome states of pre-operative screening strategies in children.


METHODS
A 14-day Markov model evaluated three strategies: (1) test all children for coagulation disorders; (2) test only those children with a pertinent history; and (3) perform no pre-operative testing. A literature search and a review of national databases estimated probabilities, costs, and utility data. Parameters then were varied widely in sensitivity analyses. Using a societal perspective and a cycle length of 1 day, we compared the strategies based on total costs and quality-adjusted life years (QALYs).


RESULTS
Total costs for the strategies were $3,200 for testing all children, $3,083 for testing only those with a history finding, and $3,077 for not testing. Total utilities were 0.02579, 0.02654, and 0.02659 QALYs, respectively. Cost-effectiveness ratios were most sensitive to variation in the cost of post-operative care and the probability of post-operative bleeding. The strategy of not testing was dominant in all sensitivity analyses.


CONCLUSIONS
Our results demonstrate that not performing preoperative testing is the most cost-effective strategy. This was persistent in sensitivity analyses, indicating that the model was robust. These data may be helpful to institutions and organizations to formulate policies regarding pre-operative coagulation for children without previous diagnoses of bleeding disorders.
Cooper
James D
JD
Division of Hematology/Oncology/BMT, Department of Pediatrics, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania 15224, USA. james.cooper@chp.edu
Smith
Kenneth J
KJ
Ritchey
A Kim
AK
D000233:Adenoidectomy / Q000191:economics*; D001780:Blood Coagulation Tests / Q000191:economics*; D002648:Child; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D006801:Humans; D008390:Markov Chains; D019057:Quality-Adjusted Life Years; D014068:Tonsillectomy / Q000191:economics*