Cost analysis of antibiotic therapy versus appendectomy for treatment of uncomplicated acute appendicitis: 5-year results of the APPAC randomized clinical trial.
Acute Disease
Administration, Intravenous
Adolescent
Adult
Anti-Bacterial Agents
/ economics
Appendectomy
/ economics
Appendicitis
/ drug therapy
Costs and Cost Analysis
Drug Administration Schedule
Drug Therapy, Combination
Equivalence Trials as Topic
Ertapenem
/ administration & dosage
Female
Finland
/ epidemiology
Follow-Up Studies
Humans
Levofloxacin
/ administration & dosage
Male
Metronidazole
/ administration & dosage
Middle Aged
Treatment Outcome
Young Adult
Journal
PloS one
ISSN: 1932-6203
Titre abrégé: PLoS One
Pays: United States
ID NLM: 101285081
Informations de publication
Date de publication:
2019
2019
Historique:
received:
25
04
2019
accepted:
10
07
2019
entrez:
26
7
2019
pubmed:
26
7
2019
medline:
17
3
2020
Statut:
epublish
Résumé
The efficacy and safety of antibiotic treatment for uncomplicated acute appendicitis has been established at long-term follow-up with the majority of recurrences shown to occur within the first year. Overall costs of antibiotics are significantly lower compared with appendectomy at short-term follow-up, but long-term durability of these cost savings is unclear. The study objective was to compare the long-term overall costs of antibiotic therapy versus appendectomy in the treatment of uncomplicated acute appendicitis in the APPAC (APPendicitis ACuta) trial at 5 years. This multicentre, non-inferiority randomized clinical trial randomly assigned 530 adult patients with CT-confirmed uncomplicated acute appendicitis to appendectomy or antibiotic treatment at six Finnish hospitals. All major costs during the 5-year follow-up were recorded, whether generated by the initial visit and subsequent treatment or possible recurrent appendicitis. Between November 2009 and June 2012, 273 patients were randomized to appendectomy and 257 to antibiotics. The overall costs of appendectomy were 1.4 times higher (p<0.001) (€5716; 95% CI: €5510 to €5925) compared with antibiotic therapy (€4171; 95% CI: €3879 to €4463) resulting in cost savings of €1545 per patient (95% CI: €1193 to €1899; p<0.001) in the antibiotic group. At 5 years, the majority (61%, n = 156) of antibiotic group patients did not undergo appendectomy. At 5-year follow-up antibiotic treatment resulted in significantly lower overall costs compared with appendectomy. As the majority of appendicitis recurrences occur within the first year after the initial antibiotic treatment, these results suggest that treating uncomplicated acute appendicitis with antibiotics instead of appendectomy results in lower overall costs even at longer-term follow-up.
Sections du résumé
BACKGROUND
The efficacy and safety of antibiotic treatment for uncomplicated acute appendicitis has been established at long-term follow-up with the majority of recurrences shown to occur within the first year. Overall costs of antibiotics are significantly lower compared with appendectomy at short-term follow-up, but long-term durability of these cost savings is unclear. The study objective was to compare the long-term overall costs of antibiotic therapy versus appendectomy in the treatment of uncomplicated acute appendicitis in the APPAC (APPendicitis ACuta) trial at 5 years.
METHODS AND FINDINGS
This multicentre, non-inferiority randomized clinical trial randomly assigned 530 adult patients with CT-confirmed uncomplicated acute appendicitis to appendectomy or antibiotic treatment at six Finnish hospitals. All major costs during the 5-year follow-up were recorded, whether generated by the initial visit and subsequent treatment or possible recurrent appendicitis. Between November 2009 and June 2012, 273 patients were randomized to appendectomy and 257 to antibiotics. The overall costs of appendectomy were 1.4 times higher (p<0.001) (€5716; 95% CI: €5510 to €5925) compared with antibiotic therapy (€4171; 95% CI: €3879 to €4463) resulting in cost savings of €1545 per patient (95% CI: €1193 to €1899; p<0.001) in the antibiotic group. At 5 years, the majority (61%, n = 156) of antibiotic group patients did not undergo appendectomy.
CONCLUSIONS
At 5-year follow-up antibiotic treatment resulted in significantly lower overall costs compared with appendectomy. As the majority of appendicitis recurrences occur within the first year after the initial antibiotic treatment, these results suggest that treating uncomplicated acute appendicitis with antibiotics instead of appendectomy results in lower overall costs even at longer-term follow-up.
Identifiants
pubmed: 31344073
doi: 10.1371/journal.pone.0220202
pii: PONE-D-19-11514
pmc: PMC6657874
doi:
Substances chimiques
Anti-Bacterial Agents
0
Metronidazole
140QMO216E
Levofloxacin
6GNT3Y5LMF
Ertapenem
G32F6EID2H
Types de publication
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e0220202Déclaration de conflit d'intérêts
I have read the journal's policy and the authors of this manuscript have the following competing interests: P.S. has received personal fees for lectures from Merck, Lilly, and Orion Pharma. All other authors have declared that no competing interests exist.
Références
BMC Surg. 2013 Feb 08;13:3
pubmed: 23394263
World J Surg. 2006 Jun;30(6):1033-7
pubmed: 16736333
World J Surg. 2017 Sep;41(9):2245-2250
pubmed: 28341916
Br J Surg. 2017 Dec;104(13):1785-1790
pubmed: 28925502
Arch Surg. 2011 Mar;146(3):308-14
pubmed: 21422362
Eur J Trauma Emerg Surg. 2018 Oct 26;:
pubmed: 30367181
Br J Surg. 2014 Jan;101(1):e9-22
pubmed: 24272924
Br J Surg. 2017 Sep;104(10):1355-1361
pubmed: 28677879
Lancet. 2008 Jul 12;372(9633):139-44
pubmed: 18582931
JAMA Surg. 2019 Feb 1;154(2):141-149
pubmed: 30427983
BMC Surg. 2018 Dec 17;18(1):117
pubmed: 30558607
Cochrane Database Syst Rev. 2010 Oct 06;(10):CD001546
pubmed: 20927725
Surgery. 2015 Sep;158(3):712-21
pubmed: 26195106
Br J Surg. 2016 May;103(6):656-667
pubmed: 26990957
JAMA. 2015 Jun 16;313(23):2340-8
pubmed: 26080338
J Trauma Acute Care Surg. 2019 Apr;86(4):722-736
pubmed: 30516592
Ann Emerg Med. 2017 Jul;70(1):1-11.e9
pubmed: 27974169
World J Surg. 2016 Oct;40(10):2305-18
pubmed: 27199000
Scand J Prim Health Care. 1997 Jun;15(2):68-75
pubmed: 9232706
JAMA. 2018 Sep 25;320(12):1259-1265
pubmed: 30264120
Br J Surg. 2009 May;96(5):473-81
pubmed: 19358184
Ann Surg. 2014 Jul;260(1):109-17
pubmed: 24646528
Lancet. 2011 May 7;377(9777):1573-9
pubmed: 21550483
Lancet. 2015 Sep 26;386(10000):1278-1287
pubmed: 26460662
J Gastrointest Surg. 2012 Oct;16(10):1929-39
pubmed: 22890606
JAMA Surg. 2016 Feb;151(2):107-8
pubmed: 26579853
BMJ Open. 2018 Nov 3;8(11):e023623
pubmed: 30391919
World J Surg. 2013 Sep;37(9):2011-7
pubmed: 23649531
Br J Surg. 2012 Apr;99(4):532-9
pubmed: 22290281
Ann Surg. 2017 May;265(5):889-900
pubmed: 27759621
J Pediatr Surg. 2016 Jan;51(1):111-6
pubmed: 26547287
JAMA Surg. 2016 May 1;151(5):408-15
pubmed: 26676711