Is Analysis of Pediatric Tonsillectomy Specimens Cost Effective
Author: University of Michigan Health System
Published: 2011/02/08 - Updated: 2022/06/10
Topic: Oral Health and Hygiene (Publications Database)
Page Content: Synopsis Definition Introduction Main Item
Synopsis: A study suggests a routine analysis of pediatric tonsillectomy specimens perhaps not be worth the costs involved. While better at identifying the disease, the microscopic examination revealed a few unsuspected problems. The incidence is so low that the researchers estimated over $750,000 would need to be spent for every case of lymphoma found. No one is suggesting that discovering hidden cancers and other diseases isn't important, Thorne says. The question is what we might be giving up elsewhere in order to find those rare cases.
Introduction
Is the routine analysis of pediatric tonsillectomy specimens worth the money? A new U-M study suggests perhaps not. Without fanfare, hundreds of thousands of children surrender their tonsils to a surgeon's scalpel each year, usually to alleviate recurring infections and obstructive sleep problems. Most of the time, the snipped tonsils are sent to a pathologist, who looks for evidence of more serious medical problems, like unsuspected cancer. But this common practice may not be cost-effective because those additional examinations rarely lead to the discovery of the hidden disease, a new University of Michigan Health System analysis shows.
Main Item
The approximately $35 million spent nationwide on such examinations each year might have more impact if spent elsewhere in the healthcare system, says the study's senior author, Marc C. Thorne, M.D., M.P.H., assistant professor of otolaryngology at the U-M Medical School.
"The question is: How do we make rational use of our health care dollars?" asks Thorne. "It's a matter both of economics and societal values."
The findings, published online ahead of print publication in the journal Otolaryngology-Head and Neck Surgery, are but a single example of the larger, ongoing debate about how to best conserve resources, create efficiencies and lower the cost of health care.
Pathologists examine tonsillectomy specimens in a visual, or "gross," examination and microscopy. Microscopic examination is nearly three times more expensive than visual inspection.
Forty-two percent of specimens receive gross analysis, 38 percent are examined under the microscope, and 20 percent are discarded without examination, according to a 2001 survey of American Academy of Otolaryngology members.
To determine the effectiveness of each practice, Thorne and his colleagues pored over data from 5,235 tonsillectomies conducted at U-M between 1996 and 2008.
A pathologist performed a visual examination in 4,186 cases and identified zero other disease cases. Meanwhile, the collective cost of those examinations is roughly $150,000.
"Looking grossly might seem like next best alternative to the expense of putting every specimen under the microscope," Thorne says. "But it may be the worst of both worlds - the data show you're unlikely to find anything, but you're still incurring significant expense."
While better at identifying the disease, the microscopic examination also revealed a few unsuspected problems. The incidence is so low that the researchers estimated over $750,000 would need to be spent for every case of lymphoma found.
Out of 1,066 microscopic examinations, 18 cases of the disease were found, all suspected before surgery - either because a patient was known to be at higher risk because they had previously received an organ transplant or a surgeon noticed something suspicious and requested additional scrutiny.
No one is suggesting that discovering hidden cancers and other diseases isn't important, Thorne says. The question is what we might be giving up elsewhere to find those rare cases.
Part of the problem is a disconnect between the service and the payment. For a parent with insurance, there might be no additional out-of-pocket cost to have their child's tonsil's examined under a microscope. But as a society, we have to balance those individual desires with the burden on the overall system, Thorne explains.
"If we're going to make a rational decision - say, 'I don't care how much it costs, missing a lymphoma in a child is unacceptable' - then we should be doing microscopy all the time. If we're doing gross analysis, we're still spending a lot of money, yet we know we're unlikely to find anything that way."
Still, routine analysis has some non-clinical benefits, such as its use in training pathologists, the authors note.
Jonathan McHugh, M.D., an assistant professor of pathology at U-M Medical School and one of the study's authors, says some pathologists may resist change because they think of themselves as the last line of defense.
"In this instance, I think the data shows we haven't been that value in that role," McHugh says.
References and Sources:
Additional U-M authors: Marc E. Nelson, M.D.; T.J. Gernon, M.D.; Joseph C. Taylor, M.D.
Reference: "Pathologic Evaluation of Routine Pediatric Tonsillectomy Specimens Analysis of Cost-Effectiveness," Otolaryngology-Head and Neck Surgery, published online Jan. 31, 2011.
Attribution/Source(s):
This quality-reviewed publication was selected for publishing by the editors of Disabled World due to its significant relevance to the disability community. Originally authored by University of Michigan Health System, and published on 2011/02/08 (Edit Update: 2022/06/10), the content may have been edited for style, clarity, or brevity. For further details or clarifications, University of Michigan Health System can be contacted at uofmhealth.org. NOTE: Disabled World does not provide any warranties or endorsements related to this article.
Explore Similar Topics
1 - Sensory Adapted Dental Rooms Reduce Autistic Children's Stress During Teeth Cleaning - Results of study of autistic children show safe and feasible adaptations to the dentist clinic environment created more relaxed, less anxious dental care experiences.
2 - Oral Thrush: Symptoms, Causes and Treatments - Information regarding Oral thrush or oral candidiasis, a condition that causes white creamy lesions in the mouth, tongue and cheeks.
3 - Orthodontic Care for Patients with Disability - New technologies in orthodontic treatment and caring for special needs patients make a difference for dental patients with disabilities.
Complete Publications Database
Page Information, Citing and Disclaimer
Disabled World is a comprehensive online resource that provides information and news related to disabilities, assistive technologies, and accessibility issues. Founded in 2004 our website covers a wide range of topics, including disability rights, healthcare, education, employment, and independent living, with the goal of supporting the disability community and their families.
Cite This Page (APA): University of Michigan Health System. (2011, February 8 - Last revised: 2022, June 10). Is Analysis of Pediatric Tonsillectomy Specimens Cost Effective. Disabled World. Retrieved November 7, 2024 from www.disabled-world.com/health/oral/tonsils.php
Permalink: <a href="https://www.disabled-world.com/health/oral/tonsils.php">Is Analysis of Pediatric Tonsillectomy Specimens Cost Effective</a>: A study suggests a routine analysis of pediatric tonsillectomy specimens perhaps not be worth the costs involved.
Disabled World provides general information only. Materials presented are never meant to substitute for qualified medical care. Any 3rd party offering or advertising does not constitute an endorsement.