Cost-effectiveness of routine imaging of suspected appendicitis

Abstract

Introduction The misdiagnosis of appendicitis and consequent removal of a normal appendix occurs in one in five patients in the UK. On the contrary, in healthcare systems with routine cross-sectional imaging of suspected appendicitis, the negative appendicectomy rate is around 5%. If we could reduce the rate in the UK to similar numbers, would this be cost effective? This study aimed to calculate the financial impact of negative appendicectomy at the Queen Alexandra Hospital and to explore whether a policy of routine imaging of such patients could reduce hospital costs. Materials and methods We performed a retrospective analysis of all appendicectomies over a 1-year period at our institution. Data were extracted on outcomes including appendix histology, operative time and length of stay to calculate the negative appendicectomy rate and to analyse costs. Results A total of 531 patients over 5 years of age had an appendicectomy. The negative appendicectomy rate was 22% (115/531). The additional financial costs of negative appendicectomy to the hospital during this period were £270,861. Universal imaging of all patients with right iliac fossa pain that could result in a 5% negative appendicectomy rate would cost between £67,200 and £165,600 per year but could save £33,896 (magnetic resonance imaging), £105,896 (computed tomography) or £132,296 (ultrasound) depending on imaging modality used. Conclusions Negative appendicectomy is still too frequent and results in additional financial burden to the health service. Routine imaging of patients with suspected appendicitis would not only reduce the negative appendicectomy rate but could lead to cost savings and a better service for our patients.

Cohort study of 1241 patients to identify predictors of negative appendicectomy

“…In Australia, reported rates are 11-36% [8][9][10][11][12][13] and 15-33% in the UK. [14][15][16][17] This is in contrast to large multi-centre retrospective analyses of the NAR in the USA, where rates are less than 5%. 18 The advent of timely, accessible imaging to assist the diagnosis of AA has aided in reducing the NAR.…”

Randomized control trial comparing an Alvarado Score-based management algorithm and current best practice in the evaluation of suspected appendicitis

“…It has been estimated that every 100 CT scans performed for suspected appendicitis prevented 21 unnecessary operations [15]. These statistics have prompted some to recommend routine CT evaluation for all patients who present with suspected appendicitis [16,17]. Analysis of our recruitment data suggests that such an approach may be preferred by certain patients.…”

Path Analysis of Hospitalization Expenses of 2,164 Appendicitis Patients at County-Level Public Hospitals in Anhui Province, China

“…Many scholars have used t-test, chi-squared test, multiple regression analysis, and other methods to explore the in uencing factors of hospitalization expenses and achieved certain results [28,29,30]. However, the in uencing factors of hospitalization expenses are complex, and there are often correlations between various factors.…”