Cost-effectiveness Analysis and Case-based Payment Norm Modeling on Appendicitis Patients at Hanoi Medical University Hospital

In the world, there are several studies comparing the cost-effectiveness between laparoscopic appendectomy and open appendectomy. But in Vietnam, health economics studies for acute appendicitis surgery in general and laparoscopic appendectomy in particular has hardly been available, and in the context of reform of the financial mechanism for payment, questions about the cost-effectiveness between the two surgical methods are particularly concerned. Therefore, we conducted a study "Cost-effectiveness analysis and case-based payment norm modeling in patients with appendectomy at Hanoi Medical University Hospital"

Study Overview

• Status: Completed
• Conditions: Acute Appendicitis
• Intervention / Treatment: Procedure: Laparoscopic appendectomy; Procedure: Open appendectomy

Detailed Description

Acute Appendicitis (AA) is a surgical emergency most common stomach. Appendicitis occurs at all ages. Recently, the rate tends to increase VRTC with age. In the United States, there are about 300,000 cases of appendectomy surgery per year. In Vietnam, according to statistics from a number of other authors showed that the rate of appendectomy surgery accounted for 40.5% - 49.8% of total number of cases of abdominal emergency. Open appendectomy (OA) has long been applied as the gold standard surgical procedure for the treatment of AA for over a century, since it was introduce by McBurrney in 1894 and still be common choice for procedure in many center. In 1981, due to the growth of endoscopic surgery, Semm first introduced the laparoscopic appendectomy, which render a minimal invasive procedure for abdomen and skin, nevertheless, its superiority over open appendectomy (OA) is still being debated. Some more recent paper demonstrate that Laparoscopic Appendectomy is the technique of choice in treatment of AA because of its clinical advantage and cost-effectiveness, however, more than 20 years later, the benefits of LA still remain a controversy for many researchers.

There are several studies comparing the cost-effectiveness between laparoscopic appendectomy and open appendectomy in the world. But in Vietnam, health economics studies for appendix removal surgery in general and laparoscopic appendectomy in particular has hardly been available, and in the context of reform of the financial mechanism for payment, questions about the cost-effectiveness between the two surgical methods are particularly concerned. Therefore, we conducted a study "Cost-effectiveness analysis and case-based payment norm modeling in patients with appendectomy at Hanoi Medical University Hospital" with two main purposes

1. Analyze cost-effectiveness between laparoscopic and open surgery in patients undergoing appendectomy at Hanoi Medical University Hospital in 2011 - 2013
2. Model case-based payment norm of appendectomy patients at Hanoi Medical University Hospital

• Study Type: Observational
• Enrollment (Actual): 322

Contacts and Locations

Study Locations

• Vietnam
  • Hanoi, Vietnam, 10000
    • Hanoi Medical University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Probability Sample

Study Population

Adult patients with clinical, laboratory, and radiological signs of acute appendicitis

Description

Inclusion Criteria:

• Laparoscopic Appendectomy patients agree to participate in research and are paid by the mode of service charge
• Laparoscopic Appendectomy patients agree to participate in research and are paid according to package medical cases

Exclusion Criteria:

• Patients with combined pathology affecting surgical outcomes
• The patient did not agree to participate in research
• Patients do not comply with treatment

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Patients undergoing laparoscopic appendectomy; Appendix removal via scope.	Procedure: Laparoscopic appendectomy; The laparoscopic appendectomy was performed with three trocars. Pneumoperitoneum was created using an open Hasson technique. The mesoappendix was divided using a harmonic scalpel or endoscopic tissue fusion device. The appendix was divided by placing one endoscopic loop and cut with harmonic scalpel. The specimen was removed through the umbilical port.
Patients undergoing open appendectomy; Open operation for removal of appendix	Procedure: Open appendectomy; The open appendectomy was carried out in the standard way with McBurney muscle splitting incision.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Average cost of hospitalization based on the final hospital bills	Total mean expense that patient pay for hospital after completing acute appendicitis treatment	2 years
Average Cost of medication	Total mean cost of drugs used during operation for removal of appendix	2 years
Overall treatment cost of acute appendicitis patient	Total amount of money that acute appendicitis patient have to spend during the time of hospitalization	From the beginning of hospital admission till discharge from hospital ((an expected average of 10 days, maximum 20 days)
Case-based cost of appendectomy	The expenses that patient pay for surgical removal of appendix accounted by case-based standardisation	2 years
Cost of appendectomy based on health care services fee	The expenses that patient pay for acute appendicitis treatment accounted in accordance with services fee of hospital	2 years

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Length of hospital stay	No. of days from surgery to discharge of hospital	from the beginning of the surgery till discharge from hospital (an expected average of 8 days, maximum 20 days)
Duration of post-operative pain	No. of days that patient experience pain after surgery	from the beginning of the surgery till discharge from hospital (an expected average of 8 days, maximum 20 days)
Degree of post-operative pain	Percentage of patients according to stratification of post-operative pain	from the beginning of the surgery till discharge from hospital (an expected average of 8 days, maximum 20 days)
Time until resumption of clear liquid and regular diet	No. of days from surgery to the resumption of clear liquid and regular diet	from the beginning of the surgery to the resumption (an expected average 2 days after the surgery
Surgical outcome at hospital discharge	Percentage of patients with good outcome at hospital discharge	2 years

Collaborators and Investigators

• Sponsor: Hanoi Medical University

Study record dates

Study Major Dates

• Study Start (Actual): January 1, 2011
• Primary Completion (Actual): December 31, 2016
• Study Completion (Actual): December 31, 2016

Study Registration Dates

• First Submitted: April 12, 2018
• First Submitted That Met QC Criteria: April 19, 2018
• First Posted (Actual): April 20, 2018

Study Record Updates

• Last Update Posted (Actual): April 20, 2018
• Last Update Submitted That Met QC Criteria: April 19, 2018
• Last Verified: April 1, 2018

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Digestive System Diseases; Infections; Gastrointestinal Diseases; Gastroenteritis; Intestinal Diseases; Cecal Diseases; Intraabdominal Infections; Appendicitis
• Other Study ID Numbers: HMU16224

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP; ICF; ANALYTIC_CODE; CSR

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No