Cost effectiveness of nonoperative management versus laparoscopic appendectomy for acute uncomplicated appendicitis

Infographic · Oct 2018 · 1 min read

In brief

Decision-tree analysis comparing nonoperative management versus laparoscopic appendectomy for acute uncomplicated appendicitis found nonoperative management without interval appendectomy to be the dominant strategy, costing $1,865 less and producing 0.03 more QALYs per patient. The model remained robust unless recurrence exceeded 40.5% or appendectomy costs dropped below $5,468.

Nonoperative management without interval appendectomy costs $1,865 less and produces 0.03 more QALYs than laparoscopic appendectomy.
Nonoperative management remains cost-effective unless recurrence exceeds 40.5% or appendectomy costs drop below $5,468.
Interval appendectomy after nonoperative management adds $4,271 in cost for minimal QALY gain (0.01).
Probabilistic analysis confirms nonoperative management without interval appendectomy is preferred in 95.6% of scenarios.
Acute uncomplicated appendicitis may not require surgery—nonoperative management warrants broader clinical adoption.

Written by the GCMD Library team from the infographic.

A presentation slide with a sage green background displaying a comparison table with three columns. The table uses simple black icons to represent operative management (surgeon and patient figures) and nonoperative management (patient in bed icon). Below the table are two text statements highlighting the key findings, with the main conclusion emphasized in dark blue text.

Background

Appendectomy remains the gold standard in the treatment of acute, uncomplicated appendicitis in the United States. Nonetheless, there is growing evidence that nonoperative management is safe and efficacious.

Methods

We constructed a decision tree to compare nonoperative management of appendicitis with laparoscopic appendectomy in otherwise healthy adults. Model variables were abstracted from a literature review, data from the Healthcare Cost and Utilization Project data, the Medicare Physician Fee schedule, and the American College of Surgeons Surgical Risk Calculator. Uncertainty surrounding parameters of the model was assessed via 1-way and probabilistic sensitivity analyses.

Results

Operative management cost $12,213 per patient. Nonoperative management without interval appendectomy (IA) was the dominant strategy, costing $1,865 less and producing 0.03 more quality-adjusted life-years (QALYs). Nonoperative management with IA cost $4,271 more than operative management, but yielded only 0.01 additional QALY. One-way sensitivity analysis suggested operative management would become the preferred strategy if the recurrence rate was >40.5% or the total cost of appendectomy was decreased to <$5,468. Probabilistic sensitivity analysis confirmed nonoperative management without IA was the preferred strategy in 95.6% of cases.

Conclusion

Nonoperative management without IA is the least costly, most effective treatment for acute, uncomplicated appendicitis and warrants further evaluation in a disease thought to be definitively surgical.

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