Should adults with recurrent acute tonsillitis have a tonsillectomy?

Problem

Tonsillectomy remains a common procedure but lacks an evidence base for recurrent acute tonsillitis in adults. In the UK and Europe, a reduction in tonsillectomies has coincided with a rise in acute adult hospital admissions for complications of tonsillitis. The NAtional randomised control Trial of Tonsillectomy In Adults (NATTINA) aimed to assess the clinical and cost effectiveness of tonsillectomy in.

Approach

A multicentre, randomised controlled trial with embedded economic evaluation conducted in 27 hospitals in the UK. Participants met National Health Service (NHS) eligibility criteria on severity of symptoms and were randomised 1:1 to either tonsillectomy within 8 weeks, or pragmatic conservative management. The primary outcome measure was the total number of sore throat days, reported weekly over 24 months following randomisation. The primary analysis was intention-to-treat (ITT). The economic evaluation estimated the incremental cost per quality-adjusted life year (QALY) gained.

Findings

The median number of sore throat days over 2 years post randomisation in the tonsillectomy group was 23 (IQR 11, 46) and in the conservative group 30 (14, 65). The ITT analysis indicated that participants randomised to tonsillectomy had an incidence rate ratio of 0·528 (95% CI: 0·428, 0·650, p<0·001) times the rate of total sore throat days of conservative management participants. Tonsillectomy was also cost-effective with an incremental cost per QALY of £4136.

Consequences

Over 24 months, adult tonsillectomy participants suffered almost 53% fewer sore throat days than those treated conservatively. Tonsillectomy was found to be cost-effective in the management of adults with recurrent sore throats.