Cost effectiveness of nonoperative management versus laparoscopic appendectomy for acute uncomplicated appendicitis

Background Appendectomy remains the gold standard in the treatment of acute, uncomplicated appendicitis in the United States. Nonetheless, there is growing evidence that nonoperative management is safe and efficacious. Methods We constructed a decision tree to compare nonoperative management of appe...

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Bibliographic Details
Published in:Surgery 2015-09, Vol.158 (3), p.712-721
Main Authors: Wu, James X., MD, Dawes, Aaron J., MD, Sacks, Greg D., MD, MPH, Brunicardi, F. Charles, MD, Keeler, Emmett B., PhD
Format: Article
Language:English
Subjects:
Acute Disease
Adult
Anti-Bacterial Agents - economics
Anti-Bacterial Agents - therapeutic use
Appendectomy - economics
Appendectomy - methods
Appendicitis - economics
Appendicitis - surgery
Appendicitis - therapy
Combined Modality Therapy - economics
Cost-Benefit Analysis
Decision Trees
Drainage - economics
Health Care Costs - statistics & numerical data
Humans
Laparoscopy - economics
Quality-Adjusted Life Years
Surgery
Treatment Outcome
United States
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Summary:Background Appendectomy remains the gold standard in the treatment of acute, uncomplicated appendicitis in the United States. Nonetheless, there is growing evidence that nonoperative management is safe and efficacious. Methods We constructed a decision tree to compare nonoperative management of appendicitis with laparoscopic appendectomy in otherwise healthy adults. Model variables were abstracted from a literature review, data from the Healthcare Cost and Utilization Project data, the Medicare Physician Fee schedule, and the American College of Surgeons Surgical Risk Calculator. Uncertainty surrounding parameters of the model was assessed via 1-way and probabilistic sensitivity analyses. Results Operative management cost $12,213 per patient. Nonoperative management without interval appendectomy (IA) was the dominant strategy, costing $1,865 less and producing 0.03 more quality-adjusted life-years (QALYs). Nonoperative management with IA cost $4,271 more than operative management, but yielded only 0.01 additional QALY. One-way sensitivity analysis suggested operative management would become the preferred strategy if the recurrence rate was >40.5% or the total cost of appendectomy was decreased to
ISSN:0039-6060
1532-7361
DOI:10.1016/j.surg.2015.06.021