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Cost effectiveness of the quality assurance and performance improvement project for suspected appendicitis study
Gilgamesh Eamer1, Victoria Turnbull2, Tessa Robinson3
1Division of Pediatric General Surgery, McMaster University, Hamilton, Ontario, Canada; McMaster Children's Hospital, Hamilton, Ontario, Canada.
Insights
The Quality Assurance and performance improvement project for suspected appendicitis (QAPPE) pathway is a cost-effective strategy for diagnosing appendicitis in children. This standardized approach reduced costs and improved patient care outcomes.
Area of Science:
- Pediatric Surgery
- Health Economics
- Quality Improvement
Background:
- Appendicitis is a common pediatric surgical emergency, posing diagnostic challenges and significant healthcare costs.
- The Quality Assurance and performance improvement project for suspected aPPEndicitis (QAPPE) study introduced a standardized pathway for diagnosis.
- This study evaluates the cost-effectiveness of the QAPPE pathway.
Purpose of the Study:
- To assess the cost-effectiveness of the standardized QAPPE appendicitis assessment pathway.
- To compare the QAPPE pathway with traditional care in pediatric patients.
- To determine if the QAPPE pathway improves diagnostic accuracy and patient outcomes.
Main Methods:
- Prospective QAPPE data (2018-2019) were compared to retrospective data (2017).
- Patients under 18 with suspected appendicitis were analyzed.
- Costing techniques and Incremental Cost-Effectiveness Ratio (ICER) were used; effectiveness measured by negative appendectomies.
Main Results:
- The QAPPE pathway (n=247) demonstrated lower patient costs ($3656.32 CAD) compared to traditional care (n=234, $3823.56 CAD).
- QAPPE was the dominant strategy in base and sensitivity analyses, favored in 64.7% of iterations.
- Traditional care showed higher admission rates and lower pediatric appendicitis scores.
Conclusions:
- The QAPPE pathway is a more cost-effective strategy for diagnosing pediatric appendicitis.
- Implementation of the QAPPE pathway improved the effectiveness of patient care.
- Standardized assessment pathways can optimize resource utilization in pediatric surgery.
Introduction:
Appendicitis is the most common pediatric emergent surgical condition, with 77,000 American pediatric admissions costing $680 million US annually. Diagnosing appendicitis can be challenging. The prospective Quality Assurance and performance improvement project for suspected aPPEndicitis (QAPPE) study implemented a standardized appendicitis assessment pathway. This current study aims to assess the cost-effectiveness of the QAPPE pathway.
Methods:
QAPPE data (February 2018-January 2019) were compared to retrospective data from the year prior (January-December 2017). Patients aged <18, presenting with suspicion of appendicitis were identified using the emergency department patient database. Patients were excluded if they were transferred from an outside center or if appendicitis was not suspected. Study arms were compared using Student's t-test and assessed with standard costing techniques. The Incremental Cost-Effectiveness Ratio (ICER) was determined. Deterministic and probabilistic sensitivity analyses of the model were performed. Effectiveness was assessed by percent of negative appendectomies where alternate diagnosis was made intraoperatively or histologically. Significance was set at p < 0.05.
Results:
QAPPE (n = 247) and traditional care (n = 234) patients were compared. Traditional care had higher admission frequency and lower pediatric appendicitis score. Demographics between all included patients and those admitted were similar overall. Patient costs were $3656.32 (95% CI $2407-$5250) Canadian (CAD) for QAPPE and $3823.56 (95% CI $2604-$5451) CAD for traditional care. QAPPE was the dominant strategy in the base model and probabilistic simulation found it favored in 64.7% of model iterations with a willingness to pay of $70,000 CAD.
Conclusion:
Using the QAPPE pathway to assess patients with suspected appendicitis reduced costs and improved effectiveness of patient care.
Level Of Evidence:
2.
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