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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