Gross Exams of Tonsils 'Not Cost-Effective,' Says Researcher

Cheryl Clark, for HealthLeaders Media , February 9, 2011

Tonsillectomies have long been one of the most commonly performed surgical procedures with about 250,000 operations performed in children a year in the U.S. Children are recommended for the procedure to curb sleep-disordered breathing or chronic infections of the tonsils.

But how frequently the operation is performed, and how often removed tonsil tissue is forwarded for more intense pathology exams is highly variable around the country, reflecting regional surgeon and otolaryngology practitioner preferences, according to the American Academy of Otolaryngology (AAO).

The microscopic tests were reimbursed by Medicare at $61.32 per patient in 2008, or double that if both tonsils underwent microscopic examination. The cost of a visual exam was $22.85.

In a statement, Thorne notes that he is not suggesting that it's not important to discover cancer and other diseases. "The question is what we might be giving up elsewhere in order to find those rare cases?"

He added, "If we're going to make a rational decision – say, 'I don't care how much it costs, missing a lymphoma in a child is unacceptable' – then we should be doing microscopy all the time. If we're just doing gross (visual) analysis, we're still spending a lot of money, yet we know we're unlikely to find anything that way."

In the paper's conclusion, the authors wrote, "This current economic analysis would tend to support a decision to either forego pathologic analysis of routine tonsillectomy specimens in children or to perform microscopic analysis routinely."

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