Peritoneal cytology for suspected acute appendicitis: an economic evaluation

Suspected acute appendicitis is a common reason for surgery. Unfortunately, diagnosis is not always simple and, in recent years, considerable attention has been devoted to developing better diagnostic techniques. Peritoneal cytology is one such technique. It is simple, minimally invasive, and has been established as clinically effective. This paper reports on an economic evaluation of peritoneal cytology, carried out at Wellington Hospital, New Zealand. The analysis is based on two trials totalling 192 patients. The perspective taken initially is that of a hospital financial manager, seeking to minimise costs. In the first trial, there was a marginal increase in overall cost per person presenting with suspected acute appendicitis, from using the test. In the second, there was a reduction. In both trials there were significant health benefits--unnecessary operations were avoided, and necessary operations done more quickly. Also, the practice developed, in the second trial, of sending patients home immediately following a negative test result. This further increased savings. We then discuss the results from a broader perspective. We conclude that the additional personal benefits--less time convalescing, and lower mortality, on average--ensure that the benefits outweigh the costs of the test.