Cost-effectiveness of Imaging Protocols for Suspected Appendicitis

Abstract

BACKGROUND: Inaccurate diagnosis of appendicitis leads to increased costs and morbidity. Ultrasound costs less than computed tomography (CT) or MRI but has lower sensitivity and may not visualize the appendix. METHODS: We conducted a cost-effectiveness analysis using a decision-analytic model of 10 imaging strategies for suspected appendicitis in a hypothetical cohort of patients: no imaging with discharge or surgery; CT only; MRI only; or staged approach with CT or MRI after 1) negative ultrasound result or ultrasound without appendix visualization, 2) ultrasound without appendix visualization, or 3) ultrasound without appendix visualization but with secondary signs of inflammation. Inputs were derived from published literature and secondary data (quality-of-life and cost data). Sensitivity analyses varied risk of appendicitis and proportion of visualized ultrasound. Outcomes were effectiveness (quality-adjusted lifeyears [QALYs]), total direct medical costs, and cost-effectiveness (cost per QALY gained). RESULTS: The most cost-effective strategy for patients at moderate risk for appendicitis is initial ultrasound, followed by CT if the appendix is not visualized but secondary signs are present (cost of $4815.03; effectiveness of 0.99694 QALYs). Other strategies were well above standard willingness-to-pay thresholds or were more costly and less effective. Cost-effectiveness was sensitive to patients' risk of appendicitis but not the proportion of visualized appendices. CONCLUSIONS: Tailored approaches to imaging based on patients' risk of appendicitis are the most cost-effective. Imaging is not cost-effective in patients with a probability ,16% or .95%. For moderate-risk patients, ultrasound without secondary signs of inflammation is sufficient even without appendix visualization.

Transcranial Sonography versus CT for Postoperative Monitoring After Decompressive Craniectomy

“…Indeed, similar findings in other surgical specialties were reported, confirming that ultrasound could provide similar diagnostic performance to other imaging modalities (CT and MRI) with a cost-effective reduction. 26,27…”

Computed Tomography for Acute Appendicitis Diagnosis and Confirmation in Men

“…A recent cost-effectiveness analysis by Jennings et al of imaging protocols for pediatric patients quotes the average cost of an abdomen and pelvis CT with contrast to be approximately $805.55 (range: $604.44-$1007.40). 16 When considering the 216 CT scans that could have been avoided in our population, we calculate an approximate savings of $173 998.80 over our 5-year study.…”

“…17 The previously cited cost-effectiveness analysis estimates the average hospital cost for appendicitis with rupture is $15 387.10 (range: $5792.20-$32 310.18) compared with the hospital cost for appendicitis without rupture of $9460.90 (range: $4559.69-$16 010.45). 16 Given the increased risk of appendiceal perforation, delaying diagnosis and treatment of appendicitis for confirmatory imaging, especially in male patients <45 years of age with classic appendicitis presentation, should be avoided.…”

Pädiatrie aktuell – Forschung kurz notiert

“…Zahlreiche frühere Studien haben Nutzen und Limitationen von Ultraschalluntersuchungen bei Appendizitisverdacht untersucht. Eine rezente Studie aus den USA beschäftigt sich nun mit der Kosteneffektivität und vergleicht dabei 4 mögliche Szenarien: i) keine Bildgebung, ii) CT als Initialdiagnostik, iii) MRT als Initialdiagnostik, iv) abgestufte Bildgebung mit Sonographie als Erstuntersuchung [2]. Die Autoren berechnen, dass Kosteneffektivität dann besteht, wenn die Wahrscheinlichkeit für das Vorliegen einer Appendizitis zwischen 16 % und 95 % liegt.…”