{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T16:20:43Z","timestamp":1787761243574,"version":"build-2784847793"},"reference-count":51,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2023,11,8]],"date-time":"2023-11-08T00:00:00Z","timestamp":1699401600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2024,5]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To determine the best timing for surgical intervention for adults with recurrent tonsillitis (RT).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A Markov model was constructed using variables and ranges based upon a literature review. A 1\u2010way sensitivity analysis was performed to evaluate the number of yearly bouts at which each algorithm (antibiotics or tonsillectomy) would be favored. A Monte\u2010Carlo probabilistic sensitivity analysis was calculated for gains and cost. Model outcomes were measured with quality\u2010adjusted life\u2010years (QALYs) and incremental cost\u2010effectiveness ratios (ICER) for tonsillectomy versus repeat antibiotic treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Patients expected to sustain a single annual tonsillitis event will have a negative QALY of 0.02 if treated with surgery and those with 2 annual events will have a QALY gain from undergoing tonsillectomy of 0.01, 3 events\u2009=\u20090.03, 4 events\u2009=\u20090.05, 5 events\u2009=\u20090.07, 6 events\u2009=\u20090.09, 7 events\u2009=\u20090.1, and 8 events\u2009=\u20090.11. These gains became meaningful only after 2\u2009years of recurrent bouts. The average cost of tonsillectomy was 3,238 USD, and the overall average cost of RT was 7,069 USD (an incremental cost of 3,831 USD). The ICER of tonsillectomy over antibiotic treatment for 1 QALY gain was 44,741 USD.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Adult patients who sustain more than 3 annual bouts of tonsillitis over a period of at least 2\u2009years will gain QALY after tonsillectomy. These gains increase proportionally to the number of yearly events and perennial episodes. The incremental costs of tonsillectomy fail to meet the NICE guidelines but are within other acceptable reference ranges.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of Evidence<\/jats:title><jats:p>NA <jats:italic>Laryngoscope<\/jats:italic>, 134:2153\u20132161, 2024<\/jats:p><\/jats:sec>","DOI":"10.1002\/lary.31139","type":"journal-article","created":{"date-parts":[[2023,11,8]],"date-time":"2023-11-08T12:36:37Z","timestamp":1699446997000},"page":"2153-2161","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Antibiotics or Tonsillectomy for Adult Recurrent Tonsillitis: Analyzing the Lesser of Two Evils"],"prefix":"10.1002","volume":"134","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-1352-2558","authenticated-orcid":false,"given":"Tommy","family":"Jacob","sequence":"first","affiliation":[{"name":"The Department of Otolaryngology, Head &amp; Neck Surgery and Maxillofacial Surgery Tel\u2010Aviv Sourasky Medical Center  Tel\u2010Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moshe","family":"Leshno","sequence":"additional","affiliation":[{"name":"The \u2018Coller\u2019 School of Management, Tel\u2010Aviv University, Both Affiliated to the Tel\u2010Aviv Faculty of Medicine Tel\u2010Aviv University  Tel\u2010Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Narin Nard","family":"Carmel\u2010Neidermann","sequence":"additional","affiliation":[{"name":"The Department of Otolaryngology, Head &amp; Neck Surgery and Maxillofacial Surgery Tel\u2010Aviv Sourasky Medical Center  Tel\u2010Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2745-2088","authenticated-orcid":false,"given":"Liyona","family":"Kampel","sequence":"additional","affiliation":[{"name":"The Department of Otolaryngology, Head &amp; Neck Surgery and Maxillofacial Surgery Tel\u2010Aviv Sourasky Medical Center  Tel\u2010Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8163-5291","authenticated-orcid":false,"given":"Anton","family":"Warshavsky","sequence":"additional","affiliation":[{"name":"The Department of Otolaryngology, Head &amp; Neck Surgery and Maxillofacial Surgery Tel\u2010Aviv Sourasky Medical Center  Tel\u2010Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3089-5979","authenticated-orcid":false,"given":"Joubran","family":"Mansour","sequence":"additional","affiliation":[{"name":"The Department of Otolaryngology, Head &amp; Neck Surgery and Maxillofacial Surgery Tel\u2010Aviv Sourasky Medical Center  Tel\u2010Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nidal","family":"Assadi","sequence":"additional","affiliation":[{"name":"The Department of Otolaryngology, Head &amp; Neck Surgery and Maxillofacial Surgery Tel\u2010Aviv Sourasky Medical Center  Tel\u2010Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nidal","family":"Muhanna","sequence":"additional","affiliation":[{"name":"The Department of Otolaryngology, Head &amp; Neck Surgery and Maxillofacial Surgery Tel\u2010Aviv Sourasky Medical Center  Tel\u2010Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gilad","family":"Horowitz","sequence":"additional","affiliation":[{"name":"The Department of Otolaryngology, Head &amp; Neck Surgery and Maxillofacial Surgery Tel\u2010Aviv Sourasky Medical Center  Tel\u2010Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,11,8]]},"reference":[{"key":"e_1_2_7_2_1","first-page":"358","article-title":"Corticosteroids for treatment of sore throat: systematic review and meta\u2010analysis of randomised trials","volume":"3887","author":"Sadeghirad B","year":"2017","journal-title":"BMJ"},{"key":"e_1_2_7_3_1","first-page":"354","article-title":"Safety of reduced antibiotic prescribing for self limiting respiratory tract infections in primary care: cohort study using electronic health records","volume":"3410","author":"Gulliford MC","year":"2016","journal-title":"BMJ"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.326.7381.138"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.39345.405243.BE"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(13)70294-9"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.27928"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1177\/0194599813519972"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.j1450"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jval.2013.02.002"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0266462321001732"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoto.2020.2944"},{"key":"e_1_2_7_13_1","first-page":"358","volume-title":"NICE's Cost Effectiveness Threshold","author":"Appleby J","year":"2007"},{"key":"e_1_2_7_14_1","volume-title":"Methods for the Economic Evaluation of Health Care Programmes","author":"Drummond MF","year":"2015"},{"key":"e_1_2_7_15_1","article-title":"Tonsillectomy or adenotonsillectomy versus non\u2010surgical treatment for chronic\/recurrent acute tonsillitis","volume":"11","author":"Burton MJ","year":"2014","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13063-015-0768-0"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/coa.12781"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.2165\/00019053-199813040-00003"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1177\/0272989X09353194"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/coa.12720"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-125-5-199609010-00008"},{"key":"e_1_2_7_22_1","volume-title":"Statistics for Social Change","author":"Horwitz L","year":"1980"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1177\/000348940611500509"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.1001\/archotol.127.11.1347"},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.1177\/000348940211101106"},{"key":"e_1_2_7_26_1","doi-asserted-by":"publisher","DOI":"10.1080\/16549716.2018.1447828"},{"issue":"9","key":"e_1_2_7_27_1","first-page":"1162","article-title":"HTA'd in the USA: a comparison of ICER in the United States with NICE in England and Wales","volume":"26","author":"Thokala P","year":"2020","journal-title":"J Manag Care Spec Pharm"},{"key":"e_1_2_7_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.otohns.2008.12.013"},{"key":"e_1_2_7_29_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoto.2013.6215"},{"key":"e_1_2_7_30_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40273-022-01232-9"},{"key":"e_1_2_7_31_1","doi-asserted-by":"publisher","DOI":"10.1111\/coa.12850"},{"key":"e_1_2_7_32_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.39140.632604.55"},{"issue":"3","key":"e_1_2_7_33_1","article-title":"Peritonsillar abscess: clinical aspects of microbiology, risk factors, and the association with parapharyngeal abscess","volume":"64","author":"Klug TE","year":"2017","journal-title":"Dan Med J"},{"key":"e_1_2_7_34_1","doi-asserted-by":"publisher","DOI":"10.1308\/rcsann.2020.7030"},{"key":"e_1_2_7_35_1","article-title":"Antibiotics for sore throat","volume":"11","author":"Spinks A","year":"2013","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_7_36_1","doi-asserted-by":"publisher","DOI":"10.1308\/003588414X13946184900363"},{"key":"e_1_2_7_37_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.24541"},{"key":"e_1_2_7_38_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005650-199806000-00002"},{"key":"e_1_2_7_39_1","doi-asserted-by":"publisher","DOI":"10.3390\/medicina58050589"},{"key":"e_1_2_7_40_1","doi-asserted-by":"publisher","DOI":"10.5664\/jcsm.4696"},{"key":"e_1_2_7_41_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12955-021-01836-3"},{"issue":"2","key":"e_1_2_7_42_1","first-page":"149","article-title":"Management of children with acute pharyngitis: a decision analysis","volume":"34","author":"Dippel DW","year":"1992","journal-title":"J Fam Pract"},{"key":"e_1_2_7_43_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijid.2020.11.193"},{"issue":"3","key":"e_1_2_7_44_1","first-page":"343","article-title":"Primary prevention of acute rheumatic fever and rheumatic heart disease with penicillin in south African children with pharyngitis: a cost\u2010effectiveness analysis","volume":"6","author":"Irlam J","year":"2013","journal-title":"Circulation"},{"key":"e_1_2_7_45_1","doi-asserted-by":"publisher","DOI":"10.3390\/pathogens9020076"},{"key":"e_1_2_7_46_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.12522"},{"key":"e_1_2_7_47_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.22708"},{"key":"e_1_2_7_48_1","doi-asserted-by":"publisher","DOI":"10.37765\/ajmc.2021.88638"},{"key":"e_1_2_7_49_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00431-011-1410-0"},{"key":"e_1_2_7_50_1","doi-asserted-by":"publisher","DOI":"10.1308\/rcsann.2017.0193"},{"key":"e_1_2_7_51_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005537-200108000-00008"},{"key":"e_1_2_7_52_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-139-2-200307150-00011"}],"container-title":["The Laryngoscope"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/lary.31139","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,7,24]],"date-time":"2024-07-24T10:51:54Z","timestamp":1721818314000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/lary.31139"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,11,8]]},"references-count":51,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2024,5]]}},"alternative-id":["10.1002\/lary.31139"],"URL":"https:\/\/doi.org\/10.1002\/lary.31139","archive":["Portico"],"relation":{},"ISSN":["0023-852X","1531-4995"],"issn-type":[{"value":"0023-852X","type":"print"},{"value":"1531-4995","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,11,8]]},"assertion":[{"value":"2023-06-14","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-10-04","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-11-08","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}