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

      Ali, Ayesha; orcid: 0000-0002-1445-6004; email: ayesha.ali17@imperial.ac.uk; Mobarak, Zina; orcid: 0000-0003-1498-9625; email: zina.mobarak20@imperial.ac.uk; Al-Jumaily, Mariam; orcid: 0000-0002-0962-291X; email: mariam.al-jumaily20@imperial.ac.uk; Anwar, Mehreen; orcid: 0000-0002-6311-6858; email: mehreen.anwar20@imperial.ac.uk; Moti, Zaeem; orcid: 0000-0002-8411-507X; email: zaeem-zunaid.moti20@imperial.ac.uk; Zaman, Nadia; orcid: 0000-0002-1667-6158; email: tahmeena.zaman17@imperial.ac.uk; Akbari, Amir Reza; orcid: 0000-0002-8009-4945; email: amir.akbari@student.manchester.ac.uk; de Preux, Laure; orcid: 0000-0002-1684-9397; email: l.depreux@imperial.ac.uk (MDPI, 2021-08-11)
      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.