Department of Surgery, UCLA David Geffen School of Medicine, Los Angeles, California.
Department of Surgery, UCLA David Geffen School of Medicine, Los Angeles, California.
J Surg Res. 2020 Nov;255:77-85. doi: 10.1016/j.jss.2020.05.028. Epub 2020 Jun 15.
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.
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.
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.
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.
非手术治疗（NOM）单纯性阑尾炎已被认为是手术治疗的一种替代方法。在最大规模的已发表随机试验（急性阑尾炎）中，患者接受了 3 天的静脉抗生素住院治疗；然而，医疗保健系统的成本影响仍不清楚。我们假设短期住院协议将比长期住院协议更具成本效益。
我们构建了一个 Markov 模型，比较了 NOM 治疗急性单纯性阑尾炎的三种方案的成本：（1）长期住院（3 天住院），（2）短期住院（1 天住院）和（3）急诊室（ED）出院。长期住院方案是基于 APPAC 试验的数据建模的。模型变量从国家数据库和文献综述中提取。进行了单因素和双因素敏感性分析，以确定不确定性对模型的影响。
长期住院治疗方案预计每位患者在 5 年内的总成本为 10735 美元。短期住院治疗方案每位患者的成本为 8026 美元，ED 出院方案的成本为 6825 美元，分别比长期住院方案低 2709 美元和 3910 美元。单因素敏感性分析表明，短期住院方案的治疗失败相对风险需要超过 6.3（绝对风险增加 31%），ED 出院方案的治疗失败相对风险需要超过 8.75（绝对风险增加 45%），以便长期住院方案具有成本效益。
在几乎所有模型情况下，使用抗生素进行非手术治疗阑尾炎的短期住院方案都具有成本效益。未来需要考虑患者的偏好和健康相关生活质量，以确定短期住院治疗方案是否具有成本效益。
