Cost-Utility Analysis of Intracapsular and Extracapsular Techniques for Pediatric Tonsillectomy

Abstract

Objectives: To determine the incremental cost-effectiveness of intracapsular pediatric tonsillectomy. Methods: A prospective cohort with cost-utility analysis included all ambulatory and observation tonsillectomies on pediatric patients (< 18 years) at a tertiary children's hospital between 2020 and 2024. Intracapsular coblation tonsillectomy (ICT) or extracapsular tonsillectomy (ECT) was performed with 30-day outcomes used for model inputs. Costs were expressed in US dollars from the perspective of a hospital system. Utility was based on published ranges. Results: There were 5425 tonsillectomies performed (604 ICT [11%] and 4821 ECT [89%]). Among 2614 ambulatory procedures, ICT was associated with lower costs (β: −426.6, 95% CI: −631.7 to −221.4, p < 0.001). Mean ambulatory ICT costs were $4716 with a quality-adjusted life year (QALY) of 0.94 yielding a cost-effectiveness (C/E) ratio of $5008/QALY. For ambulatory ECT, mean costs were $5400 with a QALY of 0.93 yielding a C/E ratio of $5777/QALY. Ambulatory ICT had an incremental cost-effectiveness ratio (ICER) of −$100,141/QALY. Among 2811 observation tonsillectomies, ICT did not impact costs with an ICT C/E ratio of $10,067/QALY and ECT C/E ratio of $10,209/QALY. The ICER for observation ICT cases was −$16,453/QALY. One-way sensitivity analysis determined that ICT revision rates less than 14.5% for ambulatory or 0.9% for observation cases produced lower costs than a single ECT. Conclusions: ICT dominates ECT for cost-effectiveness after pediatric tonsillectomy with greater advantages in ambulatory cases. Even when considering the rare potential for revision, offering ICT can substantially reduce the economic impact of this common childhood surgery. Level of Evidence: III.