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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.
Ann Hematol 2011; 90(2):145-50AH

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.

Authors+Show Affiliations

Department of Epidemiology and Biostatistics, University of South Carolina Arnold School of Public Health, Columbia, SC, USA.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

20714723

Citation

Tripathi, Avnish, et al. "Cost-effectiveness of Adenotonsillectomy in Reducing Obstructive Sleep Apnea, Cerebrovascular Ischemia, Vaso-occlusive Pain, and ACS Episodes in Pediatric Sickle Cell Disease." Annals of Hematology, vol. 90, no. 2, 2011, pp. 145-50.
Tripathi A, Jerrell JM, Stallworth JR. Cost-effectiveness of adenotonsillectomy in reducing obstructive sleep apnea, cerebrovascular ischemia, vaso-occlusive pain, and ACS episodes in pediatric sickle cell disease. Ann Hematol. 2011;90(2):145-50.
Tripathi, A., Jerrell, J. M., & Stallworth, J. R. (2011). Cost-effectiveness of adenotonsillectomy in reducing obstructive sleep apnea, cerebrovascular ischemia, vaso-occlusive pain, and ACS episodes in pediatric sickle cell disease. Annals of Hematology, 90(2), pp. 145-50. doi:10.1007/s00277-010-1048-4.
Tripathi A, Jerrell JM, Stallworth JR. Cost-effectiveness of Adenotonsillectomy in Reducing Obstructive Sleep Apnea, Cerebrovascular Ischemia, Vaso-occlusive Pain, and ACS Episodes in Pediatric Sickle Cell Disease. Ann Hematol. 2011;90(2):145-50. PubMed PMID: 20714723.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cost-effectiveness of adenotonsillectomy in reducing obstructive sleep apnea, cerebrovascular ischemia, vaso-occlusive pain, and ACS episodes in pediatric sickle cell disease. AU - Tripathi,Avnish, AU - Jerrell,Jeanette M, AU - Stallworth,James R, Y1 - 2010/08/17/ PY - 2009/11/23/received PY - 2010/08/04/accepted PY - 2010/8/18/entrez PY - 2010/8/18/pubmed PY - 2011/3/4/medline SP - 145 EP - 50 JF - Annals of hematology JO - Ann. Hematol. VL - 90 IS - 2 N2 - 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. SN - 1432-0584 UR - https://www.unboundmedicine.com/medline/citation/20714723/Cost_effectiveness_of_adenotonsillectomy_in_reducing_obstructive_sleep_apnea_cerebrovascular_ischemia_vaso_occlusive_pain_and_ACS_episodes_in_pediatric_sickle_cell_disease_ L2 - https://dx.doi.org/10.1007/s00277-010-1048-4 DB - PRIME DP - Unbound Medicine ER -