Abstract
Background
Changes in clinical care for appendicitis have impacted healthcare use associated
with treatment. We evaluated national trends and assessed factors associated with
healthcare costs for appendicitis in the United States.
Design
The Disease Expenditure Project, the Global Burden of Disease study, and the National
Inpatient Sample were used to estimate total national expenditures, per-capita costs
for incident cases, and factors associated with inpatient costs for appendicitis management,
respectively. The national estimates of appendicitis costs were obtained from 1996
to 2016. Appendicitis incidence was estimated to calculate per-capita costs. After
application of survey weights for the stratified sample design, 191,180 weighted discharges
for appendicitis from the 2016 National Inpatient Sample study were evaluated. The
Disease Expenditure Project and the Global Burden of Disease study were used to estimate
total and per-capita spending. Temporal trends were evaluated using joinpoint regression,
expressed as annual percent change. Multivariable linear regression was used to evaluate
patient factors associated with total hospital charges.
Results
In 2016, total spending on appendicitis was $9.3 billion (95% confidence interval:
$8.0–$10.8], a 2-fold increase from $4.7 billion ($4.0–$5.3) in 1996. Per-capita spending
decreased significantly after 2011 (annual percent change –3.7% [–4.4% to –2.9%]).
Patients ≥65 years accounted for 64.1% (61.1%–67.3%) of total spending for appendicitis.
The hospital charges for older patients were significantly higher among those undergoing
appendectomy.
Conclusion
Overall healthcare spending for appendicitis has doubled from 1996 to 2016, but per
capita spending has decreased since 2011, driven by improved efficiency of inpatient
care. Nearly two-thirds of spending is on patients ≥65 years, with significantly higher
costs associated with surgical management in this population.
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Article info
Publication history
Published online: January 13, 2023
Accepted:
December 11,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2022 Elsevier Inc. All rights reserved.
