Changes in healthcare utilisation for paediatric tonsillectomy and adenoidectomy in the Netherlands: a population‐based study

Clinical Otolaryngology, vol. 46, pp. 347–356

Abstract

OBJECTIVES: Tonsillectomy and adenoidectomy in children are controversial subjects with large regional variation in surgical rates, partly explained by cultural differences and lack of high-quality evidence on indications for surgery. A quality of care cycle was executed on this topic in the Netherlands. The objective of this study was to estimate changes in healthcare utilisation for paediatric tonsil surgery in the Netherlands. METHODS: Population-based data on tonsillectomies and adenoidectomies in children up to age 10 were retrieved retrospectively from Dutch administrative databases between 2005 and 2018. A change point analysis was performed to detect the most pivotal change point in surgical rates. We performed univariate analyses to compare surgical patients' characteristics before and after the pivotalpoint . Impact on healthcare budget and societal costs were estimated using current prices and data from cost-effectiveness analyses. RESULTS: The annual number of adenotonsillectomies reduced by 10 952 procedures (-39%; from 129 per 10 000 children to 87 per 10 000 children) between 2005 and 2018, and the number of adenoidectomies by 14 757 procedures (-49%; from 138 per 10 000 children to 78 per 10 000 children). The most pivotal change point was observed around 2012, accompanied by small changes in patient selection for surgery before and after 2012. An estimated €5.3 million per year was saved on the healthcare budget and €10.4 million per year on societal costs. CONCLUSION: The quality of care cycle resulted in fewer operations, with a concomitant reduction of costs. We suggest that part of these savings be invested in new research to maintain the quality of care cycle.

Authors 9

1. Juliëtte J. C. M. van Munster corresponding Aachen Department of Otorhinolaryngology and Head & Neck Surgery Leiden University Medical Center Leiden the Netherlands Department of Otorhinolaryngology and Head & Neck Surgery

   Leiden University Medical Center · Stichting Haaglanden Medisch Centrum

   Affiliation as printed

   Department of Otorhinolaryngology and Head and Neck Surgery Leiden University Medical Center Leiden the Netherlands

   University Neurosurgical Centre Holland (UNCH) Leiden University Medical Center and The Hague Medical Center (HMC) Leiden the Netherlands

   Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Center, Leiden, the Netherlands

   University Neurosurgical Centre Holland (UNCH), Leiden University Medical Center and The Hague Medical Center (HMC), Leiden, the Netherlands

2. Amir H. Zamanipoor Najafabadi Aachen

   Leiden University Medical Center · Stichting Haaglanden Medisch Centrum

   Affiliation as printed

   University Neurosurgical Centre Holland (UNCH) Leiden University Medical Center and The Hague Medical Center (HMC) Leiden the Netherlands

   University Neurosurgical Centre Holland (UNCH), Leiden University Medical Center and The Hague Medical Center (HMC), Leiden, the Netherlands

3. Janneke van ’t Hooft

   Amsterdam UMC Location University of Amsterdam · Amsterdam University Medical Centers

   Affiliation as printed

   Department of Obstetrics and Gynecology Amsterdam UMC Academic Medical Center Amsterdam the Netherlands

   Department of Obstetrics and Gynecology, Amsterdam UMC, Academic Medical Center, Amsterdam, the Netherlands

4. Teus A. van Barneveld
   Affiliation as printed

   Dutch Association of Medical Specialists Knowledge Institute Domus Medica Utrecht the Netherlands

   Dutch Association of Medical Specialists, Knowledge Institute, Domus Medica, Utrecht, the Netherlands

5. Stefan Böhringer Aachen Biomedical Data Sciences

   Leiden University Medical Center

   Affiliation as printed

   Biomedical Data Sciences Leiden University Medical Center Leiden the Netherlands

   Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands

6. Jorrit S. Visser
   Affiliation as printed

   Department of Hospital & Health Care LOGEX Amsterdam the Netherlands

   Department of Hospital & Health Care LOGEX Amsterdam the Netherlands

7. Wilco C. Peul Aachen

   Leiden University Medical Center · Stichting Haaglanden Medisch Centrum

   Affiliation as printed

   University Neurosurgical Centre Holland (UNCH) Leiden University Medical Center and The Hague Medical Center (HMC) Leiden the Netherlands

   University Neurosurgical Centre Holland (UNCH), Leiden University Medical Center and The Hague Medical Center (HMC), Leiden, the Netherlands

8. Wilbert B. van den Hout Aachen Biomedical Data Sciences

   Leiden University Medical Center

   Affiliation as printed

   Biomedical Data Sciences Leiden University Medical Center Leiden the Netherlands

   Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands

9. Peter Paul G. van Benthem Aachen Department of Otorhinolaryngology and Head & Neck Surgery Leiden University Medical Center Leiden the Netherlands Department of Otorhinolaryngology and Head & Neck Surgery

   Leiden University Medical Center

   Affiliation as printed

   Department of Otorhinolaryngology and Head and Neck Surgery Leiden University Medical Center Leiden the Netherlands

   Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Center, Leiden, the Netherlands