Cost-Utility Analysis of Antibiotics Compared with Operative Treatment in Uncomplicated Acute Appendicitis.

Abstract Background: Appendicitis is the most common acute abdominal condition affecting general surgical practice. Although appendectomy has been considered the “gold standard” treatment, it has been associated with post-operative complications. Recently, conservative treatment with antibiotics has been considered as an alternative. Therefore, this study was conducted to evaluate if antibiotics could be cost-effective when compared to laparoscopic appendectomy (LA) or open appendectomy (OA).Methods: A prospective study was undertaken to estimate health-related quality of life using a European Quality of Life–5 Dimensions questionnaire for antibiotic and operative treatment and to ascertain indirect and direct non-medical costs in a cohort between November 2018 and October 2019. An incremental cost-effectiveness ratio (ICER) at 1 month and a net benefit at 1 year after surgery were estimated. A Tornado diagram was plotted to determine one-way and probabilistic sensitivity analyses; a cost-effectiveness (CE) scatter plot and CE acceptability curve were also generated.Results: ICERs were estimated from cost-utility analysis comparisons between individual antibiotics (beta-lactam, quinolone, and cephalosporin + metronidazole), LA, and OA in uncomplicated acute appendicitis. Antibiotics showed improved cost utility compared to operative treatments with an ICER of -9,585.66 USD per utility gained at 1 month, and the net benefit at 1 year was 3,250.08 USD. Conclusions: Base on short term evaluation, antibiotics might represent a lower cost treatment option with better cost utility compared to operative treatment options in uncomplicated acute appendicitis patients. As such, antibiotic treatment might be considered as an alternative option where resources are limited to minimize complication rates associated with operative treatments.