Cost Saving of Short Hospitalization Nonoperative Management for Acute Uncomplicated Appendicitis.

Autor: Schumm MA; Department of Surgery, UCLA David Geffen School of Medicine, Los Angeles, California. Electronic address: mschumm@mednet.ucla.edu., Childers CP; Department of Surgery, UCLA David Geffen School of Medicine, Los Angeles, California., Wu JX; Department of Surgery, UCLA David Geffen School of Medicine, Los Angeles, California., Zanocco KA; Department of Surgery, UCLA David Geffen School of Medicine, Los Angeles, California.
Jazyk: angličtina
Zdroj: The Journal of surgical research [J Surg Res] 2020 Nov; Vol. 255, pp. 77-85. Date of Electronic Publication: 2020 Jun 15.
DOI: 10.1016/j.jss.2020.05.028
Abstrakt: 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.
(Copyright © 2020 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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