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.
Highlights
Appendicectomy is recommended for all patients with complicated appendicitis and cannot be ruled out [6]
The small difference in costs can be attributed to patients in the antibiotic group having a recurrence and either needing a second cycle of antibiotics or an appendicectomy within a year, increasing the overall cost for the antibiotic group
In the ACTUAA trial, despite the superior SF-12 score and antibiotics being deemed a safe option, the study still concluded that appendicectomy ‘undoubtedly remains the most effective treatment for patients with acute appendicitis’ [13]
Summary
Current UK National Health Service (NHS) guidelines recommend appendicectomy as gold standard treatment for acute uncomplicated appendicitis. A UK-based cost-utility analysis (CUA) was performed to compare appendicectomy with an antibiotic-only treatment from an NHS perspective. The nonrandomised 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. 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
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