Max A Schumm1, Christopher P Childers2, James X Wu2, Kyle A Zanocco2. 1. Department of Surgery, UCLA David Geffen School of Medicine, Los Angeles, California. Electronic address: mschumm@mednet.ucla.edu. 2. Department of Surgery, UCLA David Geffen School of Medicine, Los Angeles, California.
Abstract
BACKGROUND: Nonoperative management (NOM) of uncomplicated appendicitis has gained recognition as an alternative to surgery. In the largest published randomized trial (Appendicitis Acuta), patients received a 3-d hospital stay for intravenous antibiotics; however, cost implications for health care systems remain unknown. We hypothesized short stay protocols would be cost saving compared with a long stay protocol. MATERIALS AND METHODS: We constructed a Markov model comparing the cost of three protocols for NOM of acute uncomplicated appendicitis: (1) long stay (3-d hospitalization), (2) short stay (1-d hospitalization), and (3) emergency department (ED) discharge. The long stay protocol was modeled on data from the APPAC trial. Model variables were abstracted from national database and literature review. One-way and two-way sensitivity analyses were performed to determine the impact of uncertainty on the model. RESULTS: The long stay treatment protocol had a total 5-y projected cost of $10,735 per patient. The short stay treatment protocol costs $8026 per patient, and the ED discharge protocol costs $6,825, which was $2709 and $3910 less than the long stay protocol, respectively. One-way sensitivity analysis demonstrated that the relative risk of treatment failure with the short stay protocol needed to exceed 6.3 (absolute risk increase of 31%) and with the ED discharge protocol needed to exceed 8.75 (absolute risk increase of 45%) in order for the long stay protocol to become cost saving. CONCLUSIONS: Short duration hospitalization protocols to treat appendicitis nonoperatively with antibiotics are cost saving under almost all model scenarios. Future consideration of patient preferences and health-related quality of life will need to be made to determine if short stay treatment protocols are cost-effective.
BACKGROUND: Nonoperative management (NOM) of uncomplicated appendicitis has gained recognition as an alternative to surgery. In the largest published randomized trial (Appendicitis Acuta), patients received a 3-d hospital stay for intravenous antibiotics; however, cost implications for health care systems remain unknown. We hypothesized short stay protocols would be cost saving compared with a long stay protocol. MATERIALS AND METHODS: We constructed a Markov model comparing the cost of three protocols for NOM of acute uncomplicated appendicitis: (1) long stay (3-d hospitalization), (2) short stay (1-d hospitalization), and (3) emergency department (ED) discharge. The long stay protocol was modeled on data from the APPAC trial. Model variables were abstracted from national database and literature review. One-way and two-way sensitivity analyses were performed to determine the impact of uncertainty on the model. RESULTS: The long stay treatment protocol had a total 5-y projected cost of $10,735 per patient. The short stay treatment protocol costs $8026 per patient, and the ED discharge protocol costs $6,825, which was $2709 and $3910 less than the long stay protocol, respectively. One-way sensitivity analysis demonstrated that the relative risk of treatment failure with the short stay protocol needed to exceed 6.3 (absolute risk increase of 31%) and with the ED discharge protocol needed to exceed 8.75 (absolute risk increase of 45%) in order for the long stay protocol to become cost saving. CONCLUSIONS: Short duration hospitalization protocols to treat appendicitis nonoperatively with antibiotics are cost saving under almost all model scenarios. Future consideration of patient preferences and health-related quality of life will need to be made to determine if short stay treatment protocols are cost-effective.
Authors: David A Talan; Gregory J Moran; Anusha Krishnadasan; Sarah E Monsell; Brett A Faine; Lisandra Uribe; Amy H Kaji; Daniel A DeUgarte; Wesley H Self; Nathan I Shapiro; Joseph Cuschieri; Jacob Glaser; Pauline K Park; Thea P Price; Nicole Siparsky; Sabrina E Sanchez; David A Machado-Aranda; Jesse Victory; Patricia Ayoung-Chee; William Chiang; Joshua Corsa; Heather L Evans; Lisa Ferrigno; Luis Garcia; Quinton Hatch; Marc D Horton; Jeffrey Johnson; Alan Jones; Lillian S Kao; Anton Kelly; Daniel Kim; Matthew E Kutcher; Mike K Liang; Nima Maghami; Karen McGrane; Elizaveta Minko; Cassandra Mohr; Miriam Neufeld; Joe H Patton; Colin Rog; Amy Rushing; Amber K Sabbatini; Matthew Salzberg; Callie M Thompson; Aleksandr Tichter; Jon Wisler; Bonnie Bizzell; Erin Fannon; Sarah O Lawrence; Emily C Voldal; Danielle C Lavallee; Bryan A Comstock; Patrick J Heagerty; Giana H Davidson; David R Flum; Larry G Kessler Journal: JAMA Netw Open Date: 2022-07-01