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The National randomised controlled Trial of Tonsillectomy IN Adults (NATTINA): a clinical and cost-effectiveness study: study protocol for a randomised control trial

Rubie, Isabel, Haighton, Catherine, O'Hara, James, Rousseau, Nikki, Stocken, Deborah, Sullivan, Frank, Vale, Luke, Wilkes, Scott and Wilson, Janet (2015) The National randomised controlled Trial of Tonsillectomy IN Adults (NATTINA): a clinical and cost-effectiveness study: study protocol for a randomised control trial. BMC Trials, 16 (263). ISSN 1745-6215

Item Type: Article

Abstract

Background

The role of tonsillectomy in the management of adult tonsillitis remains uncertain and UK regional variation in tonsillectomy rates persists. Patients, doctors and health policy makers wish to know the costs and benefits of tonsillectomy against conservative management and whether therapy can be better targeted to maximise benefits and minimise risks of surgery, hence maximising cost-effective use of resources. NATTINA incorporates the first attempt to map current NHS referral criteria against other metrics of tonsil disease severity.
Methods/design

A UK multi-centre, randomised, controlled trial for adults with recurrent tonsillitis to compare the clinical and cost-effectiveness of tonsillectomy versus conservative management.

An initial feasibility study comprises qualitative interviews to investigate the practicality of the protocol, including willingness to randomise and be randomised. Approximately 20 otolaryngology staff, 10 GPs and 15 ENT patients will be recruited over 5 months in all 9 proposed main trial participating sites.

A 6-month internal pilot will then recruit 72 patients across 6 of the 9 sites. Participants will be adults with recurrent acute tonsillitis referred by a GP to secondary care. Randomisation between tonsillectomy and conservative management will be according to a blocked allocation method in a 1:1 ratio stratified by centre and baseline disease severity.

If the pilot is successful, the main trial will recruit a further 528 patients over 18 months in all 9 participating sites. All participants will be followed up for a total of 24 months, throughout which both primary and secondary outcome data will be collected. The primary outcome is the number of sore throat days experienced over the 24-month follow-up. The pilot and main trials include an embedded qualitative process evaluation.
Discussion

NATTINA is designed to evaluate the relative effectiveness and efficiency of tonsillectomy versus conservative management in patients with recurrent sore throat who are eligible for surgery. Most adult tonsil disease and surgery has an impact on economically active age groups, with individual and societal costs through loss of earnings and productivity. Avoidance of unnecessary operations and prioritisation of those individuals likely to gain most from tonsillectomy would reduce costs to the NHS and society.

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More Information

Depositing User: Paula Normington

Identifiers

Item ID: 5577
Identification Number: https://doi.org/10.1186/s13063-015-0768-0
ISSN: 1745-6215
URI: http://sure.sunderland.ac.uk/id/eprint/5577
Official URL: http://www.trialsjournal.com/content/16/1/263

Users with ORCIDS

ORCID for Scott Wilkes: ORCID iD orcid.org/0000-0003-2949-7711

Catalogue record

Date Deposited: 20 Jul 2015 13:07
Last Modified: 30 Sep 2020 11:16

Contributors

Author: Scott Wilkes ORCID iD
Author: Isabel Rubie
Author: Catherine Haighton
Author: James O'Hara
Author: Nikki Rousseau
Author: Deborah Stocken
Author: Frank Sullivan
Author: Luke Vale
Author: Janet Wilson

University Divisions

Faculty of Health Sciences and Wellbeing

Subjects

Sciences > Health Sciences

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