Healthcare costs of acute and chronic tonsillar conditions in the pediatric population in the United States.
OBJECTIVE
To determine the prevalence and healthcare costs associated with the diagnosis and treatment of acute and chronic tonsillar conditions (ACT) in children.


METHODS
Cross-sectional analysis of the 2006, 2008, and 2010 Medical Expenditure Panel Surveys.


METHODS
Pediatric patients (age < 18 years) were examined from the above mentioned database. From the linked medical conditions file, cases with a diagnosis of ACT were extracted. Ambulatory visit rates, prescription refills, and ambulatory healthcare costs were then compared between children with and without a diagnosis of ACT and acute versus chronic tonsillitis, with multivariate adjustment for age, sex, ethnicity, region, insurance coverage and comorbid conditions (e.g., asthma and otitis media).


RESULTS
A total of 74.3 million children (mean age 8.55 years, 51% male) were sampled (raw N = 28,873). Of these, 804,229 children (1.1 ± 0.1%) were diagnosed with ACT annually (mean age 7.24 years, 49.1% male); 64.6 ± 2.0% had acute tonsillitis diagnoses and 35.4 ± 2.0% suffered from chronic tonsillitis. Children with ACT incurred an additional 2.3 office visits and 2.1 prescription fills (both p < 0.001) annually compared with those without ACT, adjusting for demographic variables and medical comorbidities, but did not have an increase in emergency department visits (p = 0.123). Children with acute tonsillar diagnoses carried total healthcare expenditures of $1303 ± 390 annually versus $2401 ± 618 for those with chronic tonsillitis (p = 0.193). ACT was associated with an incremental increase in total healthcare expense of $1685 per child, annually (p < 0.001).


CONCLUSIONS
The diagnosis of ACT confers a significant incremental healthcare utilization and healthcare cost burden on children, parents and the healthcare system. With its prevalence in the United States, pediatric tonsillitis accounts for approximately $1.355 billion in incremental healthcare expense and is a significant healthcare utilization concern.


METHODS
2C.
Department of Head and Neck Surgery, David E. Geffen School of Medicine at UCLA, Los Angeles, CA, USA. Electronic address: vmduarte26@gmail.com.
Victor M
VM
Duarte
David E. Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
Caitlin L
CL
McGrath
Department of Head and Neck Surgery, David E. Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
Nina L
NL
Shapiro
Department of Otology and Laryngology, Harvard Medical School, Boston, MA, USA.
Neil
N
Bhattacharrya
D000208:Acute Disease; D000553:Ambulatory Care / Q000191:economics; D002648:Child; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D005102:Health Expenditures; D006801:Humans; D008297:Male; D009819:Office Visits / Q000706:statistics & numerical data; D014066:Palatine Tonsil; D015995:Prevalence; D014069:Tonsillitis / Q000175:diagnosis / Q000191:economics* / Q000453:epidemiology / Q000628:therapy; D014481:United States / Q000453:epidemiology
Acute and chronic tonsillitis; Children; Health care expenditures; Health care utilization; Incremental analysis