Cost-effectiveness of Celecoxib versus Ibuprofen for Post-tonsillectomy Analgesia: A Decision-analytic Model

Introduction: Post-tonsillectomy hemorrhage affects 1-6% of the 500,000 annual pediatric tonsillectomies in the United States, generating substantial morbidity and healthcare costs. Recent trial evidence suggests celecoxib reduces bleeding compared with ibuprofen, but economic implications remain unknown.

Methods: Decision-analytic model with 30-day time horizon validated using data from 12,066 consecutive pediatric tonsillectomies performed in 2024 at a tertiary children's hospital. Clinical probabilities derived from published randomized clinical trials; pathway data and baseline hemorrhage rates from institutional cohort; costs from regional facility fee schedules. Probabilistic sensitivity analysis with 2,000 Monte Carlo iterations quantified parameter uncertainty. Seven-day scheduled celecoxib plus acetaminophen (weight-tiered dosing) compared with ibuprofen plus acetaminophen. Incremental cost per major post-tonsillectomy hemorrhage (return to operating room) prevented; probability of cost-effectiveness across willingness-to-pay thresholds.

Results: Celecoxib reduced major hemorrhage from 1.80% to 1.05% (absolute risk reduction 0.75%; 95% CI, 0.62%-0.89%; number needed to treat, 134) while decreasing expected costs from $376 to $337 per patient (incremental cost, -$39; 95% CI, -$94 to -$59). The medication cost premium ($90) was offset by prevented bleeding cascade costs. Celecoxib was cost-saving and more effective (dominant strategy) in 99.9% of probabilistic iterations. One-way sensitivity analyses confirmed dominance across all plausible parameter ranges. At an institutional volume of 12,000 annual cases, celecoxib would prevent 90 major hemorrhages while saving $468,000 annually.

Conclusions: Celecoxib demonstrates economic dominance over ibuprofen for post-tonsillectomy analgesia, preventing major hemorrhages while reducing costs. Implementation should be considered standard practice absent contraindications.