University of Oulu

Haijanen J, Sippola S, Tuominen R, Grönroos J, Paajanen H, Rautio T, et al. (2019) Cost analysis of antibiotic therapy versus appendectomy for treatment of uncomplicated acute appendicitis: 5-year results of the APPAC randomized clinical trial. PLoS ONE 14(7): e0220202.

Cost analysis of antibiotic therapy versus appendectomy for treatment of uncomplicated acute appendicitis : 5-year results of the APPAC randomized clinical trial

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Author: Haijanen, Jussi1,2; Sippola, Suvi1,2; Tuominen, Risto3,4;
Organizations: 1Division of Digestive Surgery and Urology, Turku University Hospital, Turku, Finland
2Department of Surgery, University of Turku, Turku, Finland
3Department of Public Health, University of Turku, Turku, Finland
4University of Namibia, Windhoek, Namibia
5Department of Surgery, Mikkeli Central Hospital, Mikkeli, Finland
6Department of Surgery, Oulu University Hospital, Oulu, Finland
7Division of Surgery, Gastroenterology and Oncology, Tampere University Hospital, Tampere, Finland
8Department of Surgery, Jyväskylä Central Hospital, Jyväskylä, Finland
9Department of Surgery, Kuopio University Hospital, Kuopio, Finland
10Department of Biostatistics, University of Turku, Turku, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 1.1 MB)
Persistent link:
Language: English
Published: Public Library of Science, 2019
Publish Date: 2020-04-28


Background: The efficacy and safety of antibiotic treatment for uncomplicated acute appendicitis has been established at long-term follow-up with the majority of recurrences shown to occur within the first year. Overall costs of antibiotics are significantly lower compared with appendectomy at short-term follow-up, but long-term durability of these cost savings is unclear. The study objective was to compare the long-term overall costs of antibiotic therapy versus appendectomy in the treatment of uncomplicated acute appendicitis in the APPAC (APPendicitis ACuta) trial at 5 years.

Methods and findings: This multicentre, non-inferiority randomized clinical trial randomly assigned 530 adult patients with CT-confirmed uncomplicated acute appendicitis to appendectomy or antibiotic treatment at six Finnish hospitals. All major costs during the 5-year follow-up were recorded, whether generated by the initial visit and subsequent treatment or possible recurrent appendicitis. Between November 2009 and June 2012, 273 patients were randomized to appendectomy and 257 to antibiotics. The overall costs of appendectomy were 1.4 times higher (p<0.001) (€5716; 95% CI: €5510 to €5925) compared with antibiotic therapy (€4171; 95% CI: €3879 to €4463) resulting in cost savings of €1545 per patient (95% CI: €1193 to €1899; p<0.001) in the antibiotic group. At 5 years, the majority (61%, n = 156) of antibiotic group patients did not undergo appendectomy.

Conclusions: At 5-year follow-up antibiotic treatment resulted in significantly lower overall costs compared with appendectomy. As the majority of appendicitis recurrences occur within the first year after the initial antibiotic treatment, these results suggest that treating uncomplicated acute appendicitis with antibiotics instead of appendectomy results in lower overall costs even at longer-term follow-up.

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Series: PLoS one
ISSN: 1932-6203
ISSN-E: 1932-6203
ISSN-L: 1932-6203
Volume: 14
Issue: 7
Article number: e0220202
DOI: 10.1371/journal.pone.0220202
Type of Publication: A1 Journal article – refereed
Field of Science: 3126 Surgery, anesthesiology, intensive care, radiology
Funding: The primary investigator P.S. has received funding for this study from Mary and Georg C. Ehrnrooth Foundation and EVO foundation (government research grant). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Copyright information: © 2019 Haijanen et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.