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Cost-effectiveness of adenotonsillectomy in reducing obstructive sleep apnea, cerebrovascular ischemia, vaso-occlusive pain, and ACS episodes in pediatric sickle cell disease

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Abstract

In children with sickle cell disease (SCD), adenotonsillar hypertrophy or recurrent tonsillitis are frequently linked with an increased risk of obstructive sleep apnea, cerebrovascular ischemia, or frequent pain episodes and often require an adenoidectomy and/or tonsillectomy. Interventions designed to prevent these complications, control vaso-occlusive pain episodes, and avoid hospitalizations may reduce the significant personal and economic burden of SCD. This study compares episode recurrence and treatment costs for cerebrovascular ischemia, vaso-occlusive pain, acute chest syndrome (ACS), and obstructive sleep apnea in children who had an adenotonsillectomy (A/T surgery,N = 256; 11.7%) and a matched cohort of those who did not (N = 512; 23.3%) from a cohort of 2,194 children and adolescents with SCD from South Carolina’s Medicaid system. A/T surgery was associated with a significantly reduced rate of visits over time for obstructive sleep apnea and cerebrovascular ischemia (e.g., stroke, transient ischemic attacks), but not with any change in the rate of visits for vaso-occlusive pain or ACS/pneumonia visits. The rate of mean acute (emergency and inpatient) service costs was significantly decreasing over time after an increase about the time the A/T surgery was performed. The cost-effectiveness of adenoidectomy and/or tonsillectomy for treating obstructive sleep apnea and preventing cerebrovascular ischemia without increasing vaso-occlusive pain episodes or long-term acute service costs in routine clinical practice settings was demonstrated. The matched control group of SCD patients without A/T surgery contained more patients with severe vaso-occlusive pain episodes, ACS visits, and higher mean total costs over time and appears to represent a different phenotype of children with SCD.

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Acknowledgement

Data acquisition and analysis were supported by the Departments of Neuropsychiatry and Pediatrics, University of South Carolina School of Medicine. The views expressed are those of the authors and do not represent those of the funding sources or official findings of the SC Department of Health and Human Services (Medicaid). The authors thank Carla W. Roberts M.D., Assistant Professor, Department of Pediatrics, University of South Carolina School of Medicine and Wilfried J. Karmaus M.D., MPH, Professor, Department of Epidemiology and Biostatistics, University of South Carolina Arnold School of Public Health for helpful suggestions regarding study design and analyses. Drs. Tripathi, Jerrell, and Stallworth have no conflicts of interest to disclose regarding the publication of these results.

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Authors and Affiliations

  1. Department of Epidemiology and Biostatistics, University of South Carolina Arnold School of Public Health, Columbia, SC, USA

    Avnish Tripathi

  2. Department of Neuropsychiatry and Behavioral Science, University of South Carolina School of Medicine, 3555 Harden Street Extension, 15 Medical Park Suite 301, Columbia, SC, 29203, USA

    Jeanette M. Jerrell

  3. Department of Pediatrics, University of South Carolina School of Medicine, Columbia, SC, USA

    James R. Stallworth

Authors
  1. Avnish Tripathi

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  2. Jeanette M. Jerrell

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  3. James R. Stallworth

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Correspondence toJeanette M. Jerrell.

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Tripathi, A., Jerrell, J.M. & Stallworth, J.R. Cost-effectiveness of adenotonsillectomy in reducing obstructive sleep apnea, cerebrovascular ischemia, vaso-occlusive pain, and ACS episodes in pediatric sickle cell disease.Ann Hematol90, 145–150 (2011). https://doi.org/10.1007/s00277-010-1048-4

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