Cost analysis of management in acute appendicitis with CT scanning under a hospital global budgeting scheme

Background: CT scanning of the abdomen is a highly accurate diagnostic tool for acute appendicitis. However, it is still relatively expensive in Taiwan, especially in hospitals which have adopted a global budgeting scheme. The purpose of this study was to analyse the cost of the management of this disease with and without CT scanning. Method: A retrospective observational study was undertaken from 1 January to 30 June 2005. Patients with a working diagnosis of "acute appendicitis", "acute appendicitis should be ruled out" and "differential diagnosis including acute appendicitis" were enrolled in the study. Patient demographic data, chief complaints, working diagnoses, laboratory data, CT reports, surgical findings and costs in the emergency department (ED) and ward were collected. Result: A total of 266 patients were admitted to an ED with symptoms suggesting acute appendicitis. Of these, 207 underwent an emergency appendectomy. An abdominal CT scan was performed in 71% of patients with a diagnosis of "differential diagnosis including acute appendicitis", which was higher than in the other two diagnostic groups (18% and 60%). Patient age, high sensitivity C-reactive protein (hsCRP) concentration, ED stay, ED expenses and hospital stay were lower in the group that did not have a CT scan than in those who did. The net cost per patient with acute appendicitis in the group who underwent CT scanning was New Taiwan dollar (NT$) 40 728, which was nearly equal to the net cost per patient in the group without CT scanning (NT$ 39 192). Conclusion: Routine CT scanning in patients with possible appendicitis is not necessary. History taking and physical examination combined with laboratory tests are still useful and cost-effective methods of diagnosing acute appendicitis.