Division of Digestive Surgery and Urology, Turku University Hospital, Turku, Finland.
Department of Surgery, University of Turku, Turku, Finland.
Br J Surg. 2017 Sep;104(10):1355-1361. doi: 10.1002/bjs.10575. Epub 2017 Jul 5.
An increasing amount of evidence supports antibiotic therapy for treating uncomplicated acute appendicitis. The objective of this study was to compare the costs of antibiotics alone versus appendicectomy in treating uncomplicated acute appendicitis within the randomized controlled APPAC (APPendicitis ACuta) trial.
The APPAC multicentre, non-inferiority RCT was conducted on patients with CT-confirmed uncomplicated acute appendicitis. Patients were assigned randomly to appendicectomy or antibiotic treatment. All costs were recorded, whether generated by the initial visit and subsequent treatment or possible recurrent appendicitis during the 1-year follow-up. The cost estimates were based on cost levels for the year 2012.
Some 273 patients were assigned to the appendicectomy group and 257 to antibiotic treatment. Most patients randomized to antibiotic treatment did not require appendicectomy during the 1-year follow-up. In the operative group, overall societal costs (€5989·2, 95 per cent c.i. 5787·3 to 6191·1) were 1·6 times higher (€2244·8, 1940·5 to 2549·1) than those in the antibiotic group (€3744·4, 3514·6 to 3974·2). In both groups, productivity losses represented a slightly higher proportion of overall societal costs than all treatment costs together, with diagnostics and medicines having a minor role. Those in the operative group were prescribed significantly more sick leave than those in the antibiotic group (mean(s.d.) 17·0(8·3) (95 per cent c.i. 16·0 to 18·0) versus 9·2(6·9) (8·3 to 10·0) days respectively; P < 0·001). When the age and sex of the patient as well as the hospital were controlled for simultaneously, the operative treatment generated significantly more costs in all models.
Patients receiving antibiotic therapy for uncomplicated appendicitis incurred lower costs than those who had surgery.
越来越多的证据支持抗生素疗法治疗单纯性急性阑尾炎。本研究的目的是在 APPAC（急性阑尾炎抗生素治疗）试验中比较单独使用抗生素与阑尾切除术治疗单纯性急性阑尾炎的成本。
APPAC 是一项多中心、非劣效 RCT，纳入了 CT 证实的单纯性急性阑尾炎患者。患者被随机分配到阑尾切除术组或抗生素治疗组。记录所有的成本，无论是初始就诊和后续治疗产生的，还是在 1 年随访期间可能发生的复发性阑尾炎产生的。成本估计基于 2012 年的成本水平。
273 例患者被分配到阑尾切除术组，257 例患者被分配到抗生素治疗组。大多数随机接受抗生素治疗的患者在 1 年随访期间不需要进行阑尾切除术。在手术组中，总社会成本（€5989.2，95%可信区间 5787.3 至 6191.1）高 1.6 倍（€2244.8，1940.5 至 2549.1），高于抗生素组（€3744.4，3514.6 至 3974.2）。在两组中，与所有治疗成本相比，生产力损失在总社会成本中占比略高，诊断和药物的作用较小。手术组患者的病假天数明显多于抗生素组（平均值（标准差）17.0（8.3）（95%可信区间 16.0 至 18.0）与 9.2（6.9）（8.3 至 10.0）天；P < 0.001）。当同时控制患者的年龄、性别和医院时，所有模型中手术治疗的成本都显著增加。
接受单纯性阑尾炎抗生素治疗的患者比接受手术的患者成本更低。
