Changes in healthcare utilization for pediatric tonsillectomy and adenoidectomy in the Netherlands: a population-based study.
Tonsillectomy and adenoidectomy in children are controversial subjects with large regional variation in treatment, partly explained by cultural differences and lack of high-quality evidence on indications. A quality of care cycle was executed on this topic in the Netherlands. The objective of this study was to estimate changes in healthcare utilization for pediatric tonsil surgery during and after the quality of care cycle.Population-based data on tonsillectomies and adenoidectomies in children up to age 10 was retrieved retrospectively from Dutch administrative databases between 2005 and 2018. A change point analysis was performed to find the most pivotal change point in surgical rates. Surgical patients’ characteristics before and after this point were compared descriptively. Impact on healthcare budget and societal costs were estimated using current prices and cost-effectiveness analyses.The annual number of adenotonsillectomies reduced by 10952 procedures (-39%; from 12.9 per 1000 children to 8.7 per 1000 children) between 2005 and 2018, and the number of adenoidectomies by 14757 procedures (-49%; from 13.8 per 1000 children to 7.8 per 1000 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.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.