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

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BACKGROUND: 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. METHODS: 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). RESULTS: 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. CONCLUSION: 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. KEY STATEMENT: 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.

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