Impact analysis of expanding antibiotic use for treatment of uncomplicated appendicitis without appendicolith

Abstract

Aim: Approximately 20% of patients with uncomplicated appendicitis receive antibiotics as a first-line treatment; this study explores the impacts of expanding patient uptake of first-line antibiotics for appendicitis treatment. Materials & methods: We model the impacts on the patient, caregiver, payer and total societal costs associated with expanding antibiotics use from 20 to 50% for patients with appendicitis through use of a decision-tree model. Results: Increasing antibiotics uptake to 50% of eligible appendicitis patients is expected to decrease overall societal economic costs by $192 million, and these savings are driven by a $493 million reduction in initial treatment costs. For patients and their caregivers, out-of-pocket costs are expected to decrease by $18 million, appendectomies by 27,410 and missed work hours by 639,682. Conclusion: Increasing national uptake of antibiotics for the treatment of appendicitis may reduce patient, payer and total societal costs with minimal impact to patient health outcomes. An expansion may also decrease the total number of appendectomies, appendectomy-related medical complications, and lost wages for patients and caregivers, with minimal decreases in the number of appendiceal cancer cases treated early. Plain language summary: Understanding the impacts of increased antibiotic use as an alternative to appendectomy for appendicitis What is this article about? Approximately 300,000 people in the USA experience inflammation in their appendix each year, a condition that is referred to as appendicitis. Appendicitis may cause severe abdominal pain and requires immediate medical treatment to avoid life-threatening infections. Most patients undergo an appendectomy, which is surgical procedure that removes the appendix, to resolve their appendicitis. Appendectomies are generally curative for appendicitis and may help detect appendiceal cancers at earlier stages; however, appendectomies can be costly and may result in surgical complications. This study expands an existing clinical trial to understand the costs and implications to patients and caregivers of increased antibiotic use in the USA. What methodology/protocol is described? Currently, about 20% of eligible patients receive antibiotics to treat their appendicitis. We used a simulation model to assess the patient and payer impacts of expanding uptake of antibiotics to 50% of eligible patients. The model evaluated changes in health outcomes, healthcare utilization, patient and caregiver work loss and costs associated with the expansion of antibiotics treatment using a 5-year time horizon. What do the results mean? Increasing national uptake of antibiotics for the treatment of appendicitis from 20 to 50% may reduce patient, payer and total societal costs with minimal impact to patient health outcomes. The expansion would decrease the total number of appendectomies, appendectomy-related medical complications and wages, with minimal decreases in the number of appendiceal cancer cases treated early. First draft submitted: 13 December 2024; Accepted for publication: 7 March 2025; Published online: 11 April 2025