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Cost-effectiveness of prophylactic appendectomy: a Markov model.

Karina Newhall1,2, Benjamin Albright3, Anna Tosteson4,5

  • 1VA Outcomes Group, White River Junction Veterans Affairs Hospital, White River Junction, VT, USA. Karina.A.Newhall@hitcock.org.

Surgical Endoscopy
|January 13, 2017
PubMed
Summary

Prophylactic appendectomy, removing the appendix during unrelated surgery, is cost-saving for younger males and females. This strategy prevents future appendicitis risks and costs for specific patient groups.

Keywords:
AppendectomyCost utility analysisProphylactic surgical procedures

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Area of Science:

  • Surgical outcomes
  • Health economics
  • Preventive medicine

Background:

  • Appendectomy is the most common emergency surgery in the USA.
  • Incidental appendectomy during other procedures may prevent future appendicitis.
  • The cost-effectiveness of prophylactic appendectomy is not well-established.

Purpose of the Study:

  • To determine if prophylactic appendectomy is cost-saving.
  • To analyze the trade-offs between prophylactic appendectomy costs and appendicitis risks.
  • To evaluate cost-effectiveness based on patient age and gender.

Main Methods:

  • A Markov decision model was used to simulate patient cohorts (ages 18-80).
  • Cost per life-year was the primary outcome measure.
  • Data on appendicitis, treatment costs, and outcomes were extracted from literature; sensitivity analyses were performed.

Main Results:

  • Prophylactic appendectomy is cost-saving for males aged 18-27 and females aged 18-28.
  • Cost savings increase with remaining life-years and are greater for younger patients.
  • The procedure becomes less cost-effective if its risks or costs exceed those of treating appendicitis.

Conclusions:

  • Prophylactic appendectomy can be cost-saving for individuals under thirty undergoing elective surgery.
  • The decision to perform prophylactic appendectomy should consider patient age and procedure-specific risks and costs.
  • This strategy offers potential health system savings for specific demographics.