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Cost-effectiveness of Coblation compared with cold steel tonsillectomies in the UK

Published online by Cambridge University Press:  24 January 2019

J F Guest ,
K Rana  and
C Hopkins
J F Guest*
Affiliation:
Catalyst Health Economics Consultants, Rickmansworth, UK Faculty of Life Sciences and Medicine, King's College, London, UK
K Rana
Affiliation:
Catalyst Health Economics Consultants, Rickmansworth, UK
C Hopkins
Affiliation:
ENT Department, Guy's and St Thomas’ NHS Foundation Trust, London, UK
*
Author for correspondence: Professor Julian F Guest, Catalyst Health Economics Consultants, 7 Gilham Court, Ebury Road, Rickmansworth WD3 1FZ, UK E-mail: julian.guest@catalyst-health.com Fax: +44 (0)1923 450046
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Abstract

Objective

This study aimed to estimate the cost-effectiveness of Coblation compared with cold steel tonsillectomy in adult and paediatric patients in the UK.

Method

Decision analysis was undertaken by combining published clinical outcomes with resource utilisation estimates derived from a panel of clinicians.

Results

Using a cold steel procedure instead of Coblation is expected to generate an incremental cost of more than £2000 for each additional avoided haemorrhage, and the probability of cold steel being cost-effective was approximately 0.50. Therefore, the cost-effectiveness of the two techniques was comparable. When the published clinical outcomes were replaced with clinicians’ estimates of current practice, Coblation was found to improve outcome for less cost, and the probability of Coblation being cost-effective was at least 0.70.

Conclusion

A best-case scenario suggests Coblation affords the National Health Service a cost-effective intervention for tonsillectomy in adult and paediatric patients compared with cold steel procedures. A worst-case scenario suggests Coblation affords the National Health Service an equivalent cost-effective intervention for adult and paediatric patients.

Keywords

CoblationCold DissectionTonsillectomyCost-EffectivenessAdultPediatricsUnited Kingdom
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 132 , Issue 12 , December 2018 , pp. 1119 - 1127
Copyright
Copyright © JLO (1984) Limited, 2019 

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Footnotes

Prof J F Guest takes responsibility for the integrity of the content of the paper

References

1Kendrick, D, Gibbin, K. An audit of the complications of paediatric tonsillectomy, adenoidectomy and adenotonsillectomy. Clin Otolaryngol Allied Sci 1993;18:115–17Google Scholar
2Pizzuto, MP, Brodsky, L, Duffy, L, Gendler, J, Nauenberg, E. A comparison of microbipolar cautery dissection to hot knife and cold knife cautery tonsillectomy. Int J Pediatr Otorhinolaryngol 2000;52:239–46Google Scholar
3Laureyns, G, Lemkens, P, Jorissen, M. Tonsillectomy as a day-case surgery: a safe procedure? B-ENT 2006;2:109–16Google Scholar
4Husband, AD, Davis, A. Pain after tonsillectomy. Clin Otolaryngol Allied Sci 1996;21:99–101Google Scholar
5Windfuhr, JP. Serious complications following tonsillectomy: how frequent are they really? ORL J Otorhinolaryngol Relat Spec 2013;75:166–73Google Scholar
6Royal College of Surgeons of England. National Prospective Tonsillectomy Audit: Final Report of an Audit Carried out in England and Northern Ireland Between July 2003 and September 2004 Final Report. London: Royal College of Surgeons of England, 2005Google Scholar
7Timms, MS, Temple, RH. Coblation tonsillectomy: a double blind randomized controlled study. J Laryngol Otol 2002;116:450–2Google Scholar
8Royal College of Surgeons. Commissioning Guide: Tonsillectomy. London: Royal College of Surgeons, 2016Google Scholar
9Khan, I, Abelardo, E, Scott, NW, Shakeel, M, Menakaya, O, Jaramillo, M et al. Coblation tonsillectomy: is it inherently bloody? Eur Arch Otorhinolaryngol 2012;269:579–83Google Scholar
10Aksoy, F, Ozturan, O, Veyseller, B, Yildirim, YS, Demirhan, H. Comparison of radiofrequency and monopolar electrocautery tonsillectomy. J Laryngol Otol 2010;124:180–4Google Scholar
11D'Eredita, R. Tonsillectomy in children: a five-factor analysis among three techniques--reporting upon clinical results, anesthesia time, surgery time, bleeding, and cost. Laryngoscope 2010;120:2502–7Google Scholar
12Gallagher, TQ, Wilcox, L, McGuire, E, Derkay, CS. Analyzing factors associated with major complications after adenotonsillectomy in 4776 patients: comparing three tonsillectomy techniques. Otolaryngol Head Neck Surg 2010;142:886–92Google Scholar
13Roje, Ž, Skrabic, V, Stipic, SS. Coblation tonsilloadenoidectomy – treatment of choice for very small children. Signa Vitae 2014;9:63–5Google Scholar
14Soderman, AC, Odhagen, E, Ericsson, E, Hemlin, C, Hultcrantz, E, Sunnergren, O et al. Post-tonsillectomy haemorrhage rates are related to technique for dissection and for haemostasis. An analysis of 15734 patients in the National Tonsil Surgery Register in Sweden. Clin Otolaryngol 2015;40:248–54Google Scholar
15Praveen, CV, Parthiban, S, Terry, RM. High incidence of post-tonsillectomy secondary haemorrhage following coblation tonsillectomy. Indian J Otolaryngol Head Neck Surg 2013;65:24–8Google Scholar
16Blanchford, H, Lowe, D. Cold versus hot tonsillectomy: state of the art and recommendations. ORL J Otorhinolaryngol Relat Spec 2013;75:136–41Google Scholar
17Matin, M, Chowdhury, MA, Haque, ME, Islam, MN, Shamim, T, Muqeet, M et al. Coblation tonsillectomy versus blunt dissectomy tonsillectomy in children. Anwer Khan Modern Medical College Journal 2013;4:25–9Google Scholar
18Saengpanich, S, Kerekhanjanarong, V, Aramwatanapong, P, Supiyaphun, P. Comparison of pain after radiofrequency tonsillectomy compared with conventional tonsillectomy: a pilot study. J Med Assoc Thai 2005;88:1880–3Google Scholar
19Wilson, YL, Merer, DM, Moscatello, AL. Comparison of three common tonsillectomy techniques: a prospective randomized, double-blinded clinical study. Laryngoscope 2009;119:162–70Google Scholar
20Mitic, S, Tvinnereim, M, Lie, E, Saltyte, BJ. A pilot randomized controlled trial of coblation tonsillectomy versus dissection tonsillectomy with bipolar diathermy haemostasis. Clin Otolaryngol 2007;32:261–7Google Scholar
21Chang, KW. Randomized controlled trial of Coblation versus electrocautery tonsillectomy. Otolaryngol Head Neck Surg 2005;132:273–80Google Scholar
22Izny Hafiz, Z, Rosdan, S, Mohd Khairi, MD. Coblation tonsillectomy versus dissection tonsillectomy: a comparison of intraoperative time, intraoperative blood loss and post-operative pain. Med J Malaysia 2014;69:74–8Google Scholar
23NHS reference costs 2015–2016. In: https://www.gov.uk/government/publications/nhs-reference-costs-2015-to-2016 [30 January 2017]Google Scholar
24Unit costs of health and social care 2015. In: http://www.pssru.ac.uk/project-pages/unit-costs/2015/ [30 November 2016]Google Scholar
25Costing statement: blood transfusion. In: https://www.nice.org.uk/guidance/ng24/resources/costing-statement-2177158141 [30 November 2018]Google Scholar
26Mösges, R, Hellmich, M, Allekotte, S, Albrecht, K, Böhm, M. Hemorrhage rate after coblation tonsillectomy: a meta-analysis of published trials. Eur Arch Otorhinolaryngol 2011;268:807–16Google Scholar
27Hospital admitted patient care activity, 2015 to 2016. In: https://www.gov.uk/government/statistics/hospital-admitted-patient-care-activity-2015-to-2016 [30 November 2018]Google Scholar
28Hoey, AW, Foden, NM, Hadjisymeou Andreou, S, Noonan, F, Chowdhury, AK, Greig, SR et al. Coblation® intracapsular tonsillectomy (tonsillotomy) in children: a prospective study of 500 consecutive cases with long-term follow-up. Clin Otolaryngol 2017;42:1211–17Google Scholar
29Parsons, SP, Cordes, SR, Comer, B. Comparison of posttonsillectomy pain using the ultrasonic scalpel, coblator, and electrocautery. Otolaryngol Head Neck Surg 2006;134:106–13Google Scholar
30Polites, N, Joniau, S, Wabnitz, D, Fassina, R, Smythe, C, Varley, P et al. Postoperative pain following oblation tonsillectomy: randomized clinical trial. ANZ J Surg 2006;76:226–9Google Scholar
31Magdy, EA, Elwany, S, el-Daly, AS, Abdel-Hadi, M, Morshedy, MA. Coblation tonsillectomy: a prospective, double-blind, randomised, clinical and histopathological comparison with dissection-ligation, monopolar electrocautery and laser tonsillectomies. J Laryngol Otol 2008;122:282–90Google Scholar
32Shapiro, NL, Bhattacharyya, N. Cold dissection versus coblation-assisted adenotonsillectomy in children. Laryngoscope 2007;117:406–10Google Scholar
33Javed, F, Sadri, M, Uddin, J, Mortimore, S, Parker, D. A completed audit cycle on post-tonsillectomy haemorrhage rate: coblation versus standard tonsillectomy. Acta Otolaryngol 2007;127:300–4Google Scholar
34Metcalfe, C, Muzaffar, J, Daultrey, C, Coulson, C. Coblation tonsillectomy: a systematic review and descriptive analysis. Eur Arch Otorhinolaryngol 2017;274:2637–47Google Scholar