Three-year cost analysis of laparoscopic appendicectomy versus antibiotic treatment for uncomplicated appendicitis

Treatment of acute appendicitis, one of the most common surgical emergencies1, causes a major economic burden on global health care2. Previous reports suggest that in uncomplicated acute appendicitis—defined as the absence of an appendicolith, perforation, abscess, or suspicion of a tumour on imaging3,4—antibiotic management incurs significantly lower costs compared to surgery. These previous studies, however, had significant limitations, such as open surgical approach or short follow-up3 ,5. The APPAC II non-inferiority multicentre RCT6 randomized adults with uncomplicated acute appendicitis in nine Finnish hospitals to receive either oral antibiotic monotherapy or intravenous therapy followed by oral antibiotics. Based on the clinical comparability of these antibiotic therapies in the two randomized arms, the predefined 3-year cost comparison between these two antibiotics is of less clinical importance. Therefore, the present study reports a predefined secondary cost analysis of the APPAC II RCT, comparing 3-year treatment costs between antibiotics versus laparoscopic appendicectomy for the treatment of uncomplicated acute appendicitis.