title: Cost analysis of tonsillectomy in children using medicaid data.
abstract: OBJECTIVE
  To evaluate the cost-effectiveness of adenotonsillectomy (T&A) for adenotonsillar hypertrophy and recurrent tonsillitis through the use of Missouri Medicaid data.
  
  
  METHODS
  Children ages 2-16 years who had a diagnosis of adenotonsillar hypertrophy (based on medical claim codes) in 2006 (n = 4276) were included in this population-based study. The main outcome was direct total costs paid by Medicaid. Costs 2 years before and after T&A were compared in children who underwent surgical intervention with those who did not as well as costs comparison pre- and post-T&A. Wilcoxon rank-sum or Wilcoxon Signed-rank test was used for costs comparisons.
  
  
  RESULTS
  Children with adenotonsillar hypertrophy who underwent T&A were significantly less likely to be African American. They had more adenotonsillar infections before undergoing T&A and greater total costs (median costs $2313 vs. $1945; P = .009). The median costs were $1228 pre-T&A, compared with $823 post-T&A (P < .0001). This reduction in costs of $405 (33%) compares with a median cost of the procedure of $1088. The reduction in costs was mostly because of less antibiotic use and outpatient visits.
  
  
  CONCLUSIONS
  African American children have fewer T&A procedures for adenotonsillar hypertrophy than white children, which represents an unexplained racial disparity. Children with adenotonsillar hypertrophy who underwent T&A compared with those who did not had more adenotonsillar infections and greater health care costs. T&A leads to a reduction in costs that, after 2 years, is 37% of the costs of the procedure. Future studies should examine the effects of demographics, obesity, and disease severity on health care costs in children with adenotonsillar hypertrophy.
authors.affiliation: Department of Epidemiology, College for Public Health and Social Justice, Saint Louis University, St. Louis, MO. Electronic address: jjchang@slu.edu.
authors.forename: Jen Jen
authors.initials: JJ
authors.lastname: Chang
authors.affiliation: Center for Outcome Research, Saint Louis University, St. Louis, MO.
authors.forename: Paula
authors.initials: P
authors.lastname: Buchanan
authors.affiliation: Center for Outcome Research, Saint Louis University, St. Louis, MO.
authors.forename: Caroline
authors.initials: C
authors.lastname: Geremakis
authors.affiliation: Department of Health Policy and Management, University of Kansas Medical School, Kansas City, KS.
authors.forename: Kazim
authors.initials: K
authors.lastname: Sheikh
authors.affiliation: Southwestern and Children's Medical Center Dallas, University of Texas, Dallas, TX.
authors.forename: Ron B
authors.initials: RB
authors.lastname: Mitchell
mesh_terms: D000233:Adenoidectomy / Q000191:economics* / Q000706:statistics & numerical data; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D016208:Databases, Factual; D005260:Female; D017048:Health Care Costs; D006801:Humans; D015994:Incidence; D008297:Male; D008484:Medicaid / Q000191:economics*; D008923:Missouri; D015999:Multivariate Analysis; D012044:Regression Analysis; D012189:Retrospective Studies; D014068:Tonsillectomy / Q000191:economics* / Q000706:statistics & numerical data; D014481:United States