- Gil LA, et al. J Am Coll Surg. https://bit.ly/3Djb7Au.
A study of more than 1,000 pediatric patients with uncomplicated appendicitis found that nonoperative management (NOM) with antibiotics was more cost-effective than surgery over a one-year period.
Studies have shown that NOM of appendicitis is safe and effective, but it is unknown whether it is cost-effective. Researchers sought to compare the cost of NOM with that of appendectomy, which is one of costliest surgical procedures performed during inpatient stays.
Data were collected from 1,068 patients ages 7-17 between May 2015 and October 2018 at 10 tertiary children’s hospitals. Thirty-five percent of patients were in the NOM group, which received at least 24 hours of intravenous antibiotics. Sixty-five percent underwent laparoscopic appendectomy.
Costs for the initial hospitalization, readmissions and unplanned emergency department visits were estimated using data from the Pediatric Health Information System.
Patients completed a survey 30 days and one year after treatment, which asked how they were doing in daily life and their quality of life. They also reported pain and days missed from school. Results were used to calculate quality-adjusted life years (QALY) scores, which ranged from 0 (death) to 1 (perfect health).
Results showed NOM of appendicitis cost an average of $8,044 per patient, and QALY averaged 0.895. Operations cost an average of $9,791 per patient with an average of 0.884 QALYs.
While NOM was more cost-effective overall, surgery proved to be a better option in a model in which appendectomy was set at a minimal cost of $3,310 and NOM was set at a maximum cost of $15,161.
Study limitations included the patient pool from just one region of the U.S. and the omission of outpatient treatment costs.
“Our study findings add an additional benefit to the antibiotics-only approach being safe and effective for children in that this strategy is shown to be cost effective,” study co-author Peter C. Minneci, M.D., FACS, said in a press release. “In short, nonoperative management is a safe and cost-effective initial therapy and a reasonable alternative to surgery.”