Timing of elective colectomy for diverticulitis: A modeled decision analysis

Abstract

Abstract Introduction: Determining the optimal strategy for elective colectomy in diverticular disease involves a balance of the morbidity, mortality, costs and quality of life associated with both elective and expectant management. Using decision and cost analysis we simulated the clinical path after an episode of diverticulitis to determine the preferable approach. Methods: A Markov model, payer’s perspective, was constructed to evaluate the lifetime risks of death and colostomy, care costs and quality of life associated with elective colectomy after subsequent episodes of diverticulitis, using hypothetical cohorts of 35 and 50 year old patients (n = 10,000). Probabilities of clinical events and costs for the base-case analysis were derived from a large cohort using a statewide administrative database. One- and two-way sensitivity analyses were performed. Results: Elective colectomy after the fourth episode was cost-saving, yielded fewer deaths, fewer colostomies and more quality adjusted life years than operating earlier for both younger and older patients. Operating after the fourth compared to the second episode in patients older than 50 resulted in 0.5% fewer deaths, 0.7% fewer colostomies and saved $1,035/patient. In younger patients, operating after the fourth episode compared to the first resulted in 0.1% fewer deaths, 2% fewer colostomies and saved $5,429/patient. Colectomy after the fourth episode was the dominant strategy across the full range of the variables tested in the sensitivity analysis. Conclusions: Performing an elective colectomy after the fourth episode of diverticulitis was associated with lower rates of deaths and colostomy and was cost-saving for both younger and older patients.