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Article

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

1
Faculty of Medicine, Imperial College London, London SW7 2AZ, UK
2
Business School, Imperial College London, London SW7 2AZ, UK
3
Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK
4
Department of Economics and Public Policy, Business School, Imperial College London, London SW7 2AZ, UK
*
Author to whom correspondence should be addressed.
The authors are joint-first authors and contributed equally to the study.
Academic Editor: Taehwan Park
Int. J. Environ. Res. Public Health 2021, 18(16), 8473; https://doi.org/10.3390/ijerph18168473
Received: 4 July 2021 / Revised: 3 August 2021 / Accepted: 6 August 2021 / Published: 11 August 2021
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. View Full-Text
Keywords: economic evaluation; cost-utility; acute uncomplicated appendicitis; appendicectomy; antibiotic therapy economic evaluation; cost-utility; acute uncomplicated appendicitis; appendicectomy; antibiotic therapy
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MDPI and ACS Style

Ali, A.; Mobarak, Z.; Al-Jumaily, M.; Anwar, M.; Moti, Z.; Zaman, N.; Akbari, A.R.; de Preux, L. Cost-Utility Analysis of Antibiotic Therapy versus Appendicectomy for Acute Uncomplicated Appendicitis. Int. J. Environ. Res. Public Health 2021, 18, 8473. https://doi.org/10.3390/ijerph18168473

AMA Style

Ali A, Mobarak Z, Al-Jumaily M, Anwar M, Moti Z, Zaman N, Akbari AR, de Preux L. Cost-Utility Analysis of Antibiotic Therapy versus Appendicectomy for Acute Uncomplicated Appendicitis. International Journal of Environmental Research and Public Health. 2021; 18(16):8473. https://doi.org/10.3390/ijerph18168473

Chicago/Turabian Style

Ali, Ayesha, Zina Mobarak, Mariam Al-Jumaily, Mehreen Anwar, Zaeem Moti, Nadia Zaman, Amir R. Akbari, and Laure de Preux. 2021. "Cost-Utility Analysis of Antibiotic Therapy versus Appendicectomy for Acute Uncomplicated Appendicitis" International Journal of Environmental Research and Public Health 18, no. 16: 8473. https://doi.org/10.3390/ijerph18168473

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