Cost analysis of antibiotic therapy versus appendectomy for treatment of uncomplicated acute appendicitis: 5-year results of the APPAC randomized clinical trial

Abstract

<p>Background<br />The efficacy and safety of antibiotic treatment for uncomplicated acute appendicitis has<br />been established at long-term follow-up with the majority of recurrences shown to occur<br />within the first year. Overall costs of antibiotics are significantly lower compared with appendectomy<br />at short-term follow-up, but long-term durability of these cost savings is unclear.<br />The study objective was to compare the long-term overall costs of antibiotic therapy versus<br />appendectomy in the treatment of uncomplicated acute appendicitis in the APPAC (APPendicitis<br />ACuta) trial at 5 years.</p><p>Methods and findings<br />This multicentre, non-inferiority randomized clinical trial randomly assigned 530 adult<br />patients with CT-confirmed uncomplicated acute appendicitis to appendectomy or antibiotic<br />treatment at six Finnish hospitals. All major costs during the 5-year follow-up were recorded,<br />whether generated by the initial visit and subsequent treatment or possible recurrent appendicitis.<br />Between November 2009 and June 2012, 273 patients were randomized to appendectomy<br />and 257 to antibiotics. The overall costs of appendectomy were 1.4 times higher<br />(p<0.001) (€5716; 95% CI: €5510 to €5925) compared with antibiotic therapy (€4171; 95%<br />CI: €3879 to €4463) resulting in cost savings of €1545 per patient (95% CI: €1193 to €1899;<br />p<0.001) in the antibiotic group. At 5 years, the majority (61%, n = 156) of antibiotic group<br />patients did not undergo appendectomy.</p><p>Conclusions<br />At 5-year follow-up antibiotic treatment resulted in significantly lower overall costs compared<br />with appendectomy. As the majority of appendicitis recurrences occur within the first year<br />after the initial antibiotic treatment, these results suggest that treating uncomplicated acute<br />appendicitis with antibiotics instead of appendectomy results in lower overall costs even at<br />longer-term follow-up.<br /></p>