title: Tonsillectomy: a cost-effective option for childhood sore throat? Further analysis of a randomized controlled trial.
abstract: OBJECTIVE
  To compare the estimated cost-effectiveness of childhood (adeno)tonsillectomy vs medical therapy for recurrent sore throats from the intention-to-treat (ITT) analysis of a randomized controlled trial (RCT) with that modeled on the recorded timing of surgical interventions as observed in all participants irrespective of their original group allocation.
  
  
  METHODS
  A pragmatic RCT (trial) with a parallel nonrandomized patient preference group (cohort) of (adeno)tonsillectomy vs medical therapy.
  
  
  METHODS
  Five secondary care UK otolaryngology departments.
  
  
  METHODS
  Eligible children, aged 4 to 15 years, were enrolled to the trial (268) or cohort (461) groups. Outcomes included sore throat diaries, quality of life, and general practice consultations. The RCT protocol ITT analysis was compared with an as-treated analysis incorporating the cohort group, modeled to reflect the timing of tonsillectomy and the differential switch rates among the original groups.
  
  
  RESULTS
  In the RCT ITT analysis, tonsillectomy saved 3.5 sore throats, whereas the as-treated model suggested an average reduction of more than 8 sore throats in 2 years for surgery within 10 weeks of consultation, falling to only 3.5 twelve months later due to the spontaneous improvement in the medical therapy group.
  
  
  CONCLUSIONS
  In eligible UK school-age children, tonsillectomy can save up to 8 sore throats at a reasonable cost, if performed promptly. Further prospective data collection, accounting for baseline and per-trial preferences and choice, is urgently needed.
authors.affiliation: Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK. j.a.wilson@ncl.ac.uk
authors.forename: Janet A
authors.initials: JA
authors.lastname: Wilson
authors.forename: I Nick
authors.initials: IN
authors.lastname: Steen
authors.forename: Catherine A
authors.initials: CA
authors.lastname: Lock
authors.forename: Martin P
authors.initials: MP
authors.lastname: Eccles
authors.forename: Sean
authors.initials: S
authors.lastname: Carrie
authors.forename: Ray
authors.initials: R
authors.lastname: Clarke
authors.forename: Haytham
authors.initials: H
authors.lastname: Kubba
authors.forename: Chris H
authors.initials: CH
authors.lastname: Raine
authors.forename: Andrew
authors.initials: A
authors.lastname: Zarod
authors.forename: John
authors.initials: J
authors.lastname: Bond
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D006801:Humans; D008297:Male; D010612:Pharyngitis / Q000191:economics / Q000523:psychology / Q000601:surgery*; D011788:Quality of Life; D012008:Recurrence; D012189:Retrospective Studies; D014068:Tonsillectomy / Q000191:economics*; D016896:Treatment Outcome