Cost effectiveness of nonoperative management versus laparoscopic appendectomy for acute uncomplicated appendicitis
Topic overview
Decision-tree analysis comparing nonoperative management versus laparoscopic appendectomy for acute uncomplicated appendicitis found that antibiotics alone (without interval appendectomy) dominated surgical management, costing $1,865 less while producing 0.03 additional QALYs per patient. The model remained robust unless recurrence exceeded 40.5% or surgical costs dropped below $5,468.
Key takeaways
- Nonoperative management of uncomplicated appendicitis costs $1,865 less per patient than laparoscopic appendectomy while producing slightly better QALYs.
- Interval appendectomy after nonoperative management adds $4,271 in costs with minimal QALY benefit and is not cost-effective.
- Surgery becomes preferred only if appendicitis recurrence exceeds 40.5% or appendectomy costs drop below $5,468.
- Nonoperative management was the optimal strategy in 95.6% of probabilistic sensitivity analysis scenarios.
- This challenges the surgical gold standard for acute uncomplicated appendicitis in otherwise healthy adults.
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