{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T16:29:17Z","timestamp":1780676957416,"version":"3.54.1"},"reference-count":22,"publisher":"American Medical Association (AMA)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"<jats:sec><jats:title>Importance<\/jats:title><jats:p>The current treatment for adult tonsil disease, tonsillectomy (TE), may involve a burdensome recovery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To evaluate long-term efficacy (1- and 2-year efficacy) and cost-effectiveness of carbon dioxide (CO<jats:sub>2<\/jats:sub>) laser tonsillotomy (TO) vs TE.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Interventions<\/jats:title><jats:p>Tonsillectomy under general anesthesia vs CO<jats:sub>2<\/jats:sub> laser TO under local anesthesia.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main Outcomes and Measures<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>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; <jats:italic>P<\/jats:italic>\u2009&amp;amp;lt;\u2009.001); at 2 years, 45.2% vs 19.7% had persistent symptoms (OR, 3.4; 95% CI, 1.7-6.7; <jats:italic>P<\/jats:italic>\u2009&amp;amp;lt;\u2009.001). Symptom severity decreased significantly in both groups but was lower after TE at 1 year (14.8 vs 23.0 mm; mean difference, \u22128.1 mm; 95% CI, \u221214.8 to \u22121.5 mm; <jats:italic>P<\/jats:italic>\u2009=\u2009.02) and 2 years (10.8 vs 19.6 mm; mean difference, \u22128.8 mm; 95% CI, \u221214.7 to \u22122.9 mm; <jats:italic>P<\/jats:italic>\u2009=\u2009.001). 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, <jats:italic>P<\/jats:italic>\u2009=\u2009.06; EuroQol Visual Analogue Scale: mean, 1.83 vs 1.81, mean difference, 0.02; <jats:italic>P<\/jats:italic>\u2009=\u2009.38). Tonsillotomy had lower overall costs ($869 vs $2363 for TE), with societal cost savings of $1925 (<jats:italic>P<\/jats:italic>\u2009=\u2009.001), and a 71% probability of cost-effectiveness at $25\u202f907 per QALY (85%-93% in sensitivity analyses).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions and Relevance<\/jats:title><jats:p>The findings of this trial suggest that both CO<jats:sub>2<\/jats:sub> 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, CO<jats:sub>2<\/jats:sub>-laser TO appears to be a safe, effective, and cost-effective method for long-term relief of tonsil-related problems with excellent patient satisfaction.<\/jats:p><\/jats:sec><jats:sec><jats:title>Trial Registration<\/jats:title><jats:p>trialregister.nl Identifier: <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/onderzoekmetmensen.nl\/nl\/trial\/29298\">NL 6866<\/jats:ext-link><\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.4858","type":"journal-article","created":{"date-parts":[[2025,4,29]],"date-time":"2025-04-29T15:31:52Z","timestamp":1745940712000},"page":"e254858","source":"Crossref","is-referenced-by-count":4,"title":["Long-Term Efficacy and Cost-Effectiveness of Laser Tonsillotomy vs Tonsillectomy"],"prefix":"10.1001","volume":"8","author":[{"given":"Justin Emile Raoul Edouard","family":"Wong Chung","sequence":"first","affiliation":[{"name":"Department of 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