A cost‐effectiveness analysis of coagulation testing prior to tonsillectomy and adenoidectomy in children

Background The American Society of Pediatric Otolaryngology recommends pre‐operative coagulation testing only when indicated by history or physical exam. Nevertheless, many surgeons test all children scheduled for tonsillectomy and/or adenoidectomy (T&A). Studies of pre‐operative screening have had conflicting results. A decision analysis model was constructed to address the costs and health outcome states of pre‐operative screening strategies in children. Procedure A 14‐day Markov model evaluated three strategies: (1) test all children for coagulation disorders; (2) test only those children with a pertinent history; and (3) perform no pre‐operative testing. A literature search and a review of national databases estimated probabilities, costs, and utility data. Parameters then were varied widely in sensitivity analyses. Using a societal perspective and a cycle length of 1 day, we compared the strategies based on total costs and quality‐adjusted life years (QALYs). Results Total costs for the strategies were $3,200 for testing all children, $3,083 for testing only those with a history finding, and $3,077 for not testing. Total utilities were 0.02579, 0.02654, and 0.02659 QALYs, respectively. Cost‐effectiveness ratios were most sensitive to variation in the cost of post‐operative care and the probability of post‐operative bleeding. The strategy of not testing was dominant in all sensitivity analyses. Conclusions Our results demonstrate that not performing preoperative testing is the most cost‐effective strategy. This was persistent in sensitivity analyses, indicating that the model was robust. These data may be helpful to institutions and organizations to formulate policies regarding pre‐operative coagulation for children without previous diagnoses of bleeding disorders. Pediatr Blood Cancer. 2010;55:1153–1159. © 2010 Wiley‐Liss, Inc.