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Research
Cesar Augusto Guevara-Cuellar
Universidad Icesi
Corresponding Author
ORCiD: https://orcid.org/0000-0002-4412-0261
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background
Traditionally, uncomplicated acute appendicitis (AA) has been treated with appendectomy. However, the surgical alternatives might carry out significant complications, impaired quality of life, and higher costs than nonoperative treatment. In consequence it is necessary to evaluate the efficiency of the different therapeutic alternatives in patients diagnosed with uncomplicated appendicitis.
Methods
We performed a model-based cost-effectiveness analysis comparing nonoperative management (NOM) with open appendectomy (OA) and laparoscopic appendectomy (LA) in patients otherwise healthy adults aged 18 years and older with a diagnosis of uncomplicated AA in the Colombian health system. The time horizon was five years. A discount rate of 5% was applied to both costs and outcomes. The health outcomes were quality-adjusted life years (QALYs). Costs were identified, quantified, and valorized from a payer perspective; therefore, only direct health costs were included. An incremental analysis was estimated to determine the incremental cost-effectiveness ratio (ICER). In addition, the net monetary benefit (NMB) was calculated for each alternative using a willingness to pay lower than a one gross domestic product. A deterministic and probabilistic sensitivity analysis was performed.
Results
LA presents a lower cost ($ 363±35) than OA ($ 384±41) and NOM ($392±44). NOM exhibited higher QALYs (3.3332±0.0276) in contrast with LA (3.3310± 0.057) and OA (3.3261±0.0707). LA dominated the OA. The ICER between LA and NOM was $24 000/QALY. LA has a 52% probability of generating the highest NMB versus its counterparts, followed by NOM (30%) and OA (18%). There is a probability of 0.69 that laparoscopy generates more significant benefit than medical management. The mean value of that incremental NMB would be $93.7 per patient.
Conclusions
LA is more likely to produce more significant monetary benefits than NOM and OA in uncomplicated AA. This feature becomes the most efficient alternative as long as the conditions for its adequate performance exist. However, NOM may be a more acceptable alternative from the patient's perspective or when only the OA option is available.
Keywords
cost-effectiveness, nonoperative management, open appendectomy, laparoscopic appendectomy, acute appendicitis
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Peer Review Timeline
CURRENT STATUS: Under Revision
Version 1
Posted 15 Mar, 2021
No community comments so far
Review #4 received
Received 28 Mar, 2021
Editorial decision: Major Revision
On 28 Mar, 2021
Review #6 received
Received 20 Mar, 2021
Review #5 received
Received 18 Mar, 2021
Review #2 received
Received 17 Mar, 2021
Review #3 received
Received 17 Mar, 2021
Review #1 received
Received 14 Mar, 2021
Reviewer #6 agreed
On 07 Mar, 2021
Reviewer #5 agreed
On 04 Mar, 2021
Reviewer #2 agreed
On 03 Mar, 2021
Reviewer #3 agreed
On 03 Mar, 2021
Reviewer #4 agreed
On 03 Mar, 2021
Reviewers invited
Invitations sent on 03 Mar, 2021
Reviewer #1 agreed
On 03 Mar, 2021
First submitted
On 02 Mar, 2021
Editor assigned
On 02 Mar, 2021
Submission checks complete
On 02 Mar, 2021
Editor invited
On 02 Mar, 2021
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Health Economics & Outcomes Research
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This preprint is under consideration at Cost Effectiveness and Resource Allocation. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research
Cesar Augusto Guevara-Cuellar
Universidad Icesi
Corresponding Author
ORCiD: https://orcid.org/0000-0002-4412-0261
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Revision
Version 1
Posted 15 Mar, 2021
No community comments so far
Review #4 received
Received 28 Mar, 2021
Editorial decision: Major Revision
On 28 Mar, 2021
Review #6 received
Received 20 Mar, 2021
Review #5 received
Received 18 Mar, 2021
Review #2 received
Received 17 Mar, 2021
Review #3 received
Received 17 Mar, 2021
Review #1 received
Received 14 Mar, 2021
Reviewer #6 agreed
On 07 Mar, 2021
Reviewer #5 agreed
On 04 Mar, 2021
Reviewer #2 agreed
On 03 Mar, 2021
Reviewer #3 agreed
On 03 Mar, 2021
Reviewer #4 agreed
On 03 Mar, 2021
Reviewers invited
Invitations sent on 03 Mar, 2021
Reviewer #1 agreed
On 03 Mar, 2021
First submitted
On 02 Mar, 2021
Editor assigned
On 02 Mar, 2021
Submission checks complete
On 02 Mar, 2021
Editor invited
On 02 Mar, 2021
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Health Economics & Outcomes Research
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background
Traditionally, uncomplicated acute appendicitis (AA) has been treated with appendectomy. However, the surgical alternatives might carry out significant complications, impaired quality of life, and higher costs than nonoperative treatment. In consequence it is necessary to evaluate the efficiency of the different therapeutic alternatives in patients diagnosed with uncomplicated appendicitis.
Methods
We performed a model-based cost-effectiveness analysis comparing nonoperative management (NOM) with open appendectomy (OA) and laparoscopic appendectomy (LA) in patients otherwise healthy adults aged 18 years and older with a diagnosis of uncomplicated AA in the Colombian health system. The time horizon was five years. A discount rate of 5% was applied to both costs and outcomes. The health outcomes were quality-adjusted life years (QALYs). Costs were identified, quantified, and valorized from a payer perspective; therefore, only direct health costs were included. An incremental analysis was estimated to determine the incremental cost-effectiveness ratio (ICER). In addition, the net monetary benefit (NMB) was calculated for each alternative using a willingness to pay lower than a one gross domestic product. A deterministic and probabilistic sensitivity analysis was performed.
Results
LA presents a lower cost ($ 363±35) than OA ($ 384±41) and NOM ($392±44). NOM exhibited higher QALYs (3.3332±0.0276) in contrast with LA (3.3310± 0.057) and OA (3.3261±0.0707). LA dominated the OA. The ICER between LA and NOM was $24 000/QALY. LA has a 52% probability of generating the highest NMB versus its counterparts, followed by NOM (30%) and OA (18%). There is a probability of 0.69 that laparoscopy generates more significant benefit than medical management. The mean value of that incremental NMB would be $93.7 per patient.
Conclusions
LA is more likely to produce more significant monetary benefits than NOM and OA in uncomplicated AA. This feature becomes the most efficient alternative as long as the conditions for its adequate performance exist. However, NOM may be a more acceptable alternative from the patient's perspective or when only the OA option is available.
Figure 1
Figure 2
Figure 3
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