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

Author

Listed:
  • Ayesha Ali

    (Faculty of Medicine, Imperial College London, London SW7 2AZ, UK
    The authors are joint-first authors and contributed equally to the study.)

  • Zina Mobarak

    (Business School, Imperial College London, London SW7 2AZ, UK
    The authors are joint-first authors and contributed equally to the study.)

  • Mariam Al-Jumaily

    (Business School, Imperial College London, London SW7 2AZ, UK)

  • Mehreen Anwar

    (Business School, Imperial College London, London SW7 2AZ, UK)

  • Zaeem Moti

    (Business School, Imperial College London, London SW7 2AZ, UK)

  • Nadia Zaman

    (Faculty of Medicine, Imperial College London, London SW7 2AZ, UK)

  • Amir Reza Akbari

    (Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK)

  • Laure de Preux

    (Department of Economics and Public Policy, Business School, Imperial College London, London SW7 2AZ, UK)

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.

Suggested Citation

  • Ayesha Ali & Zina Mobarak & Mariam Al-Jumaily & Mehreen Anwar & Zaeem Moti & Nadia Zaman & Amir Reza Akbari & Laure de Preux, 2021. "Cost-Utility Analysis of Antibiotic Therapy versus Appendicectomy for Acute Uncomplicated Appendicitis," IJERPH, MDPI, vol. 18(16), pages 1-15, August.
    • Handle: RePEc:gam:jijerp:v:18:y:2021:i:16:p:8473-:d:612243
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    References listed on IDEAS

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    1. Jussi Haijanen & Suvi Sippola & Risto Tuominen & Juha Grönroos & Hannu Paajanen & Tero Rautio & Pia Nordström & Markku Aarnio & Tuomo Rantanen & Saija Hurme & Paulina Salminen, 2019. "Cost analysis of antibiotic therapy versus appendectomy for treatment of uncomplicated acute appendicitis: 5-year results of the APPAC randomized clinical trial," PLOS ONE, Public Library of Science, vol. 14(7), pages 1-12, July.
    2. Gafni, Amiram, 1989. "The quality of QALYs (quality-adjusted-life-years): do QALYs measure what they at least intend to measure?," Health Policy, Elsevier, vol. 13(1), pages 81-83, October.
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