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

Ayesha Ali, Zina Mobarak, Mariam Al-Jumaily, Mehreen Anwar, Zaeem Moti, Nadia Zaman, Amir Reza Akbari and Laure de Preux
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Ayesha Ali: Faculty of Medicine, Imperial College London, London SW7 2AZ, UK
Zina Mobarak: Business School, Imperial College London, London SW7 2AZ, UK
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

IJERPH, 2021, vol. 18, issue 16, 1-15

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: economic evaluation; cost-utility; acute uncomplicated appendicitis; appendicectomy; antibiotic therapy (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2021
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