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Multicenter Study
. 2021 Aug 11;18(16):8473.
doi: 10.3390/ijerph18168473.

Cost-Utility Analysis of Antibiotic Therapy versus Appendicectomy for Acute Uncomplicated Appendicitis

Ayesha Ali  1 , Zina Mobarak  2 , Mariam Al-Jumaily  2 , Mehreen Anwar  2 , Zaeem Moti  2 , Nadia Zaman  1 , Amir Reza Akbari  3 , Laure de Preux  4
Affiliations
Multicenter Study

Cost-Utility Analysis of Antibiotic Therapy versus Appendicectomy for Acute Uncomplicated Appendicitis

Ayesha Ali et al. Int J Environ Res Public Health. .

Abstract

Background: Current UK National Health Service (NHS) guidelines recommend appendicectomy as gold standard treatment for acute uncomplicated appendicitis. However, an alternative non-surgical management involves administrating antibiotic-only therapy with significantly lower costs. Therefore, a UK-based cost-utility analysis (CUA) was performed to compare appendicectomy with an antibiotic-only treatment from an NHS perspective.

Methods: This economic evaluation modelled health-outcome data using the ACTUAA (2021) prospective multicentre trial. The non-randomised control trial followed 318 patients given either antibiotic therapy or appendicectomy, with quality of life (QOL) assessed using the SF-12 questionnaires administered 1-year post-treatment. A CUA was conducted over a 1-year time horizon, measuring benefits in quality adjusted life years (QALYs) and costs in pound sterling using a propensity score-matched approach to control for selection based on observable factors.

Results: The CUA produced an incremental cost-effectiveness ratio (ICER) of -GBP 23,278.51 (-EUR 27,227.80) per QALY. Therefore, for each QALY gained using antibiotic-only treatment instead of appendicectomy, an extra GBP 23,278.51 was saved. Additionally, two sensitivity analyses were conducted to account for post-operative or post-treatment complications. The antibiotic-only option remained dominant in both scenarios.

Conclusion: While the results do not rely on a randomized sample, the analysis based on a 1-year follow-up suggested that antibiotics were largely more cost-effective than appendicectomy and led to improved QOL outcomes for patients. The ICER value of -GBP 23,278.51 demonstrates that the NHS must give further consideration to the current gold standard treatment in acute uncomplicated appendicitis.

Keywords: acute uncomplicated appendicitis; antibiotic therapy; appendicectomy; cost-utility; economic evaluation.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Decision tree.
Figure 2
Figure 2
Costs extracted from the decision tree.
Figure 3
Figure 3
Cost-effectiveness plane diagram; ICER 0 = original; ICER 1 = sensitivity analysis 1; ICER 2 = sensitivity analysis 2.
See this image and copyright information in PMC

References

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