Long-Term Efficacy and Cost-Effectiveness of Laser Tonsillotomy vs Tonsillectomy: A Secondary Analysis of a Randomized Clinical Trial.

IMPORTANCE

The current treatment for adult tonsil disease, tonsillectomy (TE), may involve a burdensome recovery.

OBJECTIVE

To evaluate long-term efficacy (1- and 2-year efficacy) and cost-effectiveness of carbon dioxide (CO2) laser tonsillotomy (TO) vs TE.

DESIGN, SETTING, AND PARTICIPANTS: A prespecified secondary analysis of a randomized clinical trial was conducted in 5 Dutch hospitals. Participants included adults with persistent tonsil-related symptoms enrolled from January 25, 2018, to December 17, 2019. Data analysis was performed from January 5, 2025, to April 9, 2025.

INTERVENTIONS

Tonsillectomy under general anesthesia vs CO2 laser TO under local anesthesia.

MAIN OUTCOMES AND MEASURES

Intention-to-treat analysis on primary (persistent symptoms, defined as an answer of yes to the question of whether symptoms were still present, reported at 1 and 2 years) and secondary (symptom severity, patient satisfaction, quality-adjusted life-years [QALYs], and cost-effectiveness) outcomes.

RESULTS

In total, 98 patients were assigned to TO and 101 to TE; 98 were analyzed per group. The TO and TE groups were similar (69 [70%] vs 67 [68%] female; mean [SD] age, 29 [10] vs 30 [8] years). The most common symptom was sore throat with fever (34% vs 34%), with a baseline mean (SD) severity score of 57 (19) vs 59 (17) mm. At 1 year, 51.8% of patients assigned to TO had persistent symptoms vs 25.2% assigned to TE (odds ratio [OR], 3.2; 95% CI, 1.6-6.4; P < .001); at 2 years, 45.2% vs 19.7% had persistent symptoms (OR, 3.4; 95% CI, 1.7-6.7; P < .001). Symptom severity decreased significantly in both groups but was lower after TE at 1 year (14.8 vs 23.0 mm; mean difference, -8.1 mm; 95% CI, -14.8 to -1.5 mm; P = .02) and 2 years (10.8 vs 19.6 mm; mean difference, -8.8 mm; 95% CI, -14.7 to -2.9 mm; P = .001). Patient satisfaction was similar between groups; mean VAS scores were 79.0 (95% CI, 72.2-85.9) mm for TE and 69.3 (95% CI, 63.4-75.3) mm for TO at 1 year and 64.1 (95% CI, 55.7-72.5) mm and 64.4 (95% CI, 56.9-71.8) mm at 2 years. Similar proportions of participants would recommend the procedure at 1 year (79% TE vs 76% TO) and 2 years (71%, both). Both TE and TO demonstrated high cumulative QALYs at 2 years (EuroQol 5 Dimension: mean, 1.89 vs 1.84; mean difference, 0.05, P = .06; EuroQol Visual Analogue Scale: mean, 1.83 vs 1.81, mean difference, 0.02; P = .38). Tonsillotomy had lower overall costs ($869 vs $2363 for TE), with societal cost savings of $1925 (P = .001), and a 71% probability of cost-effectiveness at $25 907 per QALY (85%-93% in sensitivity analyses).

CONCLUSIONS AND RELEVANCE

The findings of this trial suggest that both CO2 laser TO and TE under general anesthesia significantly reduced long-term symptoms, with greater reduction after TE. TO had lower cost and similar patient satisfaction. Based on these findings, CO2-laser TO appears to be a safe, effective, and cost-effective method for long-term relief of tonsil-related problems with excellent patient satisfaction.

TRIAL REGISTRATION

trialregister.nl Identifier: NL 6866.