This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS
Cost‐effectiveness analysis of a multicentre randomized clinical trial comparing surgery with conservative management for recurrent and ongoing diverticulitis (DIRECT trial). BJS 2019; 106: 448-457.
Published: 19th December 2018
Authors: H. E. Bolkenstein, G. A. de Wit, E. C. J. Consten, B. J. M. Van de Wall, I. A. M. J. Broeders, W. A. Draaisma et al.
Background
The results of the DIRECT trial, an RCT comparing conservative management with elective sigmoid resection in patients with recurrent diverticulitis or persistent complaints, showed that elective sigmoid resection leads to higher quality of life. The aim of this study is to determine the cost‐effectiveness of surgical treatment at 1‐ and 5‐year follow‐up from a societal perspective.
Method
Clinical effectiveness and resource use were derived from the DIRECT trial. The actual resource use and quality of life (EQ‐5D‐3L™ score) were documented prospectively per individual patient and analysed according to the intention‐to‐treat principle for up to 5 years after randomization. The main outcome was the incremental cost‐effectiveness ratio (ICER), expressed as costs per quality‐adjusted life‐year (QALY).
Results
The study included 106 patients, of whom 50 were randomized to surgery and 56 to conservative treatment. At 1‐ and 5‐year follow‐up an incremental effect (QALY difference between groups) of 0·06 and 0·43 respectively was found, and an incremental cost (cost difference between groups) of €6957 and €2674 respectively, where surgery was more expensive than conservative treatment. This resulted in an ICER of €123 365 per additional QALY at 1‐year follow‐up, and €6275 at 5 years. At a threshold of €20 000 per QALY, operative treatment has 0 per cent probability of being cost‐effective at 1‐year follow‐up, but a 95 per cent probability at 5 years.
Conclusion
At 5‐year follow‐up, elective sigmoid resection in patients with recurring diverticulitis or persistent complaints was found to be cost‐effective. Registration number: NTR1478 (
You may also be interested in
Leading article
Authors: C. Chamberlain, J. M. Blazeby
Original article
Authors: S. J. Chapman, R. C. Grossman, M. E. B. FitzPatrick, R. R. W. Brady
Systematic review
Authors: J. H. H. Olsen, S. Öberg, K. Andresen, T. W. Klausen, J. Rosenberg
Original article
Authors: L. Heylen, J. Pirenne, U. Samuel, I. Tieken, M. Coemans, M. Naesens et al.
Systematic review
Authors: H. K. James, A. W. Chapman, G. T. R. Pattison, D. R. Griffin, J. D. Fisher
Original article
Authors: L. Cairncross, H. A. Snow, D. C. Strauss, M. J. F. Smith, O. Sjokvist, C. Messiou et al.
Original article
Authors: R. J. Dinsdale, J. Hazeldine, K. Al Tarrah, P. Hampson, A. Devi, C. Ermogenous et al.
Original article
Authors: C. A. Sewalt, E. Venema, E. J. A. Wiegers, F. E. Lecky, S. C. E. Schuit, D. den Hartog et al.
Article
Authors: A. M Lacy, R. Bravo, A. M. Otero‐Piñeiro, R. Pena, F. B. De Lacy, R. Menchaca et al.
Original article
Authors: P. Ghorbani, T. Troëng, O. Brattström, K. G. Ringdal, T. Eken, A. Ekbom et al.
Original article
Authors: E. H. Wright, M. Tyler, B. Vojnovic, J. Pleat, A. Harris, D. Furniss et al.
Original article
Authors: S. Nougaret, F. Castan, H. Forges, H. A. Vargas, B. Gallix, S. Gourgou et al.