Cost utility analysis of antibiotics compared with operative treatment in uncomplicated acute appendicitis

Abstract

Appendicitis is the most common acute abdominal condition affecting general surgical practice. Recently, conservative treatment with antibiotics has been considered as an alternative. Therefore, this study was conducted to evaluate if antibiotics could be cost-effective compared to laparoscopic appendectomy or open appendectomy. A prospective study was undertaken to estimate health-related quality of life for antibiotic and operative treatment, and to ascertain costs in a cohort. A societal perspective incremental cost-effectiveness ratio (ICER) at 1 year after surgery was estimated. A probabilistic sensitivity analyses was performed. ICERs were estimated comparisons between individual antibiotics, laparoscopic appendectomy, and open appendectomy in uncomplicated acute appendicitis. Antibiotics showed improved cost savings compared to operative treatments with an ICER of -113,973.09 USD per quality adjusted life year at 1 year. Based on one year findings, antibiotics represent a lower cost treatment option with better cost-utility compared to operative treatment options in uncomplicated acute appendicitis patients. As such, antibiotic treatment can be initially considered as an alternative option where resources are limited to minimize complication rates associated with operative treatments.