S Sippola1,2, J Grönroos1,2, R Tuominen3,4,5, H Paajanen6,7, T Rautio8, P Nordström9, M Aarnio10, T Rantanen11,12, S Hurme13, P Salminen1,2. 1. Division of Digestive Surgery and Urology, Turku University Hospital, Turku, Finland. 2. Department of Surgery, University of Turku, Turku, Finland. 3. Department of Public Health, University of Turku, Turku, Finland. 4. Primary Health Care Unit, Hospital District of Southwest Finland, Turku, Finland. 5. University of Namibia, Windhoek, Namibia. 6. Department of Surgery, Mikkeli Central Hospital, Mikkeli, Finland. 7. Institute of Clinical Medicine, University of Eastern Finland, Joensuu, Finland. 8. Department of Surgery, Oulu University Hospital, Oulu, Finland. 9. Division of Surgery, Gastroenterology and Oncology, Tampere University Hospital, Tampere, Finland. 10. Department of Surgery, Jyväskylä Central Hospital, Jyväskylä, Finland. 11. Department of Surgery, Kuopio University Hospital, Kuopio, Finland. 12. Department of Surgery, Seinäjoki Central Hospital, Seinäjoki, Finland. 13. Department of Biostatistics, University of Turku, Turku, Finland.
Abstract
BACKGROUND: An increasing amount of evidence supports antibiotic therapy for treating uncomplicated acute appendicitis. The objective of this study was to compare the costs of antibiotics alone versus appendicectomy in treating uncomplicated acute appendicitis within the randomized controlled APPAC (APPendicitis ACuta) trial. METHODS: The APPAC multicentre, non-inferiority RCT was conducted on patients with CT-confirmed uncomplicated acute appendicitis. Patients were assigned randomly to appendicectomy or antibiotic treatment. All costs were recorded, whether generated by the initial visit and subsequent treatment or possible recurrent appendicitis during the 1-year follow-up. The cost estimates were based on cost levels for the year 2012. RESULTS: Some 273 patients were assigned to the appendicectomy group and 257 to antibiotic treatment. Most patients randomized to antibiotic treatment did not require appendicectomy during the 1-year follow-up. In the operative group, overall societal costs (€5989·2, 95 per cent c.i. 5787·3 to 6191·1) were 1·6 times higher (€2244·8, 1940·5 to 2549·1) than those in the antibiotic group (€3744·4, 3514·6 to 3974·2). In both groups, productivity losses represented a slightly higher proportion of overall societal costs than all treatment costs together, with diagnostics and medicines having a minor role. Those in the operative group were prescribed significantly more sick leave than those in the antibiotic group (mean(s.d.) 17·0(8·3) (95 per cent c.i. 16·0 to 18·0) versus 9·2(6·9) (8·3 to 10·0) days respectively; P < 0·001). When the age and sex of the patient as well as the hospital were controlled for simultaneously, the operative treatment generated significantly more costs in all models. CONCLUSION: Patients receiving antibiotic therapy for uncomplicated appendicitis incurred lower costs than those who had surgery.
RCT Entities:
BACKGROUND: An increasing amount of evidence supports antibiotic therapy for treating uncomplicated acute appendicitis. The objective of this study was to compare the costs of antibiotics alone versus appendicectomy in treating uncomplicated acute appendicitis within the randomized controlled APPAC (APPendicitis ACuta) trial. METHODS: The APPAC multicentre, non-inferiority RCT was conducted on patients with CT-confirmed uncomplicated acute appendicitis. Patients were assigned randomly to appendicectomy or antibiotic treatment. All costs were recorded, whether generated by the initial visit and subsequent treatment or possible recurrent appendicitis during the 1-year follow-up. The cost estimates were based on cost levels for the year 2012. RESULTS: Some 273 patients were assigned to the appendicectomy group and 257 to antibiotic treatment. Most patients randomized to antibiotic treatment did not require appendicectomy during the 1-year follow-up. In the operative group, overall societal costs (€5989·2, 95 per cent c.i. 5787·3 to 6191·1) were 1·6 times higher (€2244·8, 1940·5 to 2549·1) than those in the antibiotic group (€3744·4, 3514·6 to 3974·2). In both groups, productivity losses represented a slightly higher proportion of overall societal costs than all treatment costs together, with diagnostics and medicines having a minor role. Those in the operative group were prescribed significantly more sick leave than those in the antibiotic group (mean(s.d.) 17·0(8·3) (95 per cent c.i. 16·0 to 18·0) versus 9·2(6·9) (8·3 to 10·0) days respectively; P < 0·001). When the age and sex of the patient as well as the hospital were controlled for simultaneously, the operative treatment generated significantly more costs in all models. CONCLUSION:Patients receiving antibiotic therapy for uncomplicated appendicitis incurred lower costs than those who had surgery.
Authors: Suvi Sippola; Jussi Haijanen; Lauri Viinikainen; Juha Grönroos; Hannu Paajanen; Tero Rautio; Pia Nordström; Markku Aarnio; Tuomo Rantanen; Saija Hurme; Jukka-Pekka Mecklin; Juhani Sand; Airi Jartti; Paulina Salminen Journal: JAMA Surg Date: 2020-04-01 Impact factor: 14.766
Authors: Salomone Di Saverio; Mauro Podda; Belinda De Simone; Marco Ceresoli; Goran Augustin; Alice Gori; Marja Boermeester; Massimo Sartelli; Federico Coccolini; Antonio Tarasconi; Nicola De' Angelis; Dieter G Weber; Matti Tolonen; Arianna Birindelli; Walter Biffl; Ernest E Moore; Michael Kelly; Kjetil Soreide; Jeffry Kashuk; Richard Ten Broek; Carlos Augusto Gomes; Michael Sugrue; Richard Justin Davies; Dimitrios Damaskos; Ari Leppäniemi; Andrew Kirkpatrick; Andrew B Peitzman; Gustavo P Fraga; Ronald V Maier; Raul Coimbra; Massimo Chiarugi; Gabriele Sganga; Adolfo Pisanu; Gian Luigi De' Angelis; Edward Tan; Harry Van Goor; Francesco Pata; Isidoro Di Carlo; Osvaldo Chiara; Andrey Litvin; Fabio C Campanile; Boris Sakakushev; Gia Tomadze; Zaza Demetrashvili; Rifat Latifi; Fakri Abu-Zidan; Oreste Romeo; Helmut Segovia-Lohse; Gianluca Baiocchi; David Costa; Sandro Rizoli; Zsolt J Balogh; Cino Bendinelli; Thomas Scalea; Rao Ivatury; George Velmahos; Roland Andersson; Yoram Kluger; Luca Ansaloni; Fausto Catena Journal: World J Emerg Surg Date: 2020-04-15 Impact factor: 5.469
Authors: Tyler J Loftus; Camille G Dessaigne; Chasen A Croft; R Stephen Smith; Philip A Efron; Frederick A Moore; Scott C Brakenridge; Alicia M Mohr; Janeen R Jordan Journal: J Trauma Acute Care Surg Date: 2018-02 Impact factor: 3.313
Authors: Suvi Sippola; Jussi Haijanen; Juha Grönroos; Tero Rautio; Pia Nordström; Tuomo Rantanen; Tarja Pinta; Imre Ilves; Anne Mattila; Jukka Rintala; Eliisa Löyttyniemi; Saija Hurme; Ville Tammilehto; Harri Marttila; Sanna Meriläinen; Johanna Laukkarinen; Eeva-Liisa Sävelä; Heini Savolainen; Tomi Sippola; Markku Aarnio; Hannu Paajanen; Paulina Salminen Journal: JAMA Date: 2021-01-26 Impact factor: 56.272