The Cost-Effectiveness of Conservatively Managed Acute Appendicitis Versus Appendicectomy: A Systematic Review

Appendicectomy remains the gold standard treatment for acute appendicitis. While there is continued debate as to the clinical benefit of conservative treatment in acute appendicitis, the cost-effectiveness of each treatment is a critical consideration. The aim of this study is to evaluate the current health economic evidence for surgery versus conservative management in acute appendicitis.

A systematic literature search of 3 online databases for evidence pertaining to the economics of appendectomy compared with conservative management was performed according to PRISMA standards. The study protocol was prospectively registered with PROSPERO (study ID: CRD42023412691).

A total of 1219 patients were included (639 operative treatment vs. 580 conservative management). A total of 5 studies were included. Surgery was significantly more expensive when compared with conservative treatment (16.5% to 83.0%) percentage cost difference. The average length of hospitalisation was similar between the groups. The majority of studies reported a 12-month follow-up. The CHEERS assessment revealed a considerable risk of bias.

Conservative management of appendicitis is the more economically effective treatment of the 2 modalities. This is an important consideration for resource-limited health care systems. However, further research with standardized methodologies and longer-term follow-up is warranted to fully assess the economic implications and clinical effectiveness of both treatment approaches.

Analysis indicates conservative management as the economically preferable option for acute appendicitis over surgery. This finding underscores its potential significance for resource-constrained health care systems. However, standardized studies with extended follow-up in different global health care settings are required to evaluate the economic and clinical merits of both treatment strategies.