Cost-Effectiveness Analysis of Early Colectomy vs Percutaneous Drain Placement with Interval Colectomy for Complicated Diverticulitis with Abscess Formation

BACKGROUND: The optimal timing of nonemergent colectomy for complicated diverticulitis remains controversial. Early colectomy is associated with increased rates of stoma formation and length of stay, whereas interval colectomy prolongs disease management and is subject to repeat diverticulitis flares. We hypothesized that early colectomy is the more cost-effective strategy compared with interval colectomy, yielding lower total cost and improved patient outcomes. STUDY DESIGN: A tree-based decision analysis model was constructed for a reference patient with complicated diverticulitis with associated abscess. Probabilities, utilities (quality-adjusted life years, QALYs), and cost were sourced from secondary literature and Merative Marketscan claims data (2017 to 2022). "Early colectomy" was defined as a nonemergent colectomy between 48 hours and 30 days of admission. "Interval colectomy" was defined as a nonemergent colectomy 31 to 120 days after admission following percutaneous drainage. The primary outcome was incremental cost-effectiveness ratio, and secondary outcomes were total economic cost and effectiveness (QALYs). A probabilistic sensitivity analysis was performed to account for uncertainty. RESULTS: Early colectomy was associated with lower cost (8, 852 less per patient) and better clinical benefit (0. 57 QALYs incremental increase) compared with interval colectomy. This conclusion was satisfied in 96. 0% of cases. The threshold QALY decrement from percutaneous drainage to maintain the cost-effectiveness of early colectomy was 0. 044 (out of 1 QALY). CONCLUSIONS: Early colectomy was the dominant strategy for the surgical management of complicated diverticulitis and should be considered more frequently. However, interval colectomy may represent the optimal option if temporary percutaneous drain placement does not impact patient quality of life or if patients have a strong external preference to delay intervention. This threshold for strategy variation emphasizes the importance of shared decision-making with patients in cases of acute complicated diverticulitis.