Digestive Diseases and Sciences

, Volume 47, Issue 9, pp 1903–1908

Timing of Prophylactic Surgery in Prevention of Diverticulitis Recurrence: A Cost-Effectiveness Analysis

Authors

  • Robert J. Richards
    • Department of GastroenterologyUniversity of Kansas Medical Center
  • James K. Hammitt
    • Center for Risk Analysis, Harvard School of Public Health
Article

DOI: 10.1023/A:1019624101225

Cite this article as:
Richards, R.J. & Hammitt, J.K. Dig Dis Sci (2002) 47: 1903. doi:10.1023/A:1019624101225

Abstract

Although surgery is recommended after two or more attacks of uncomplicated diverticulitis, the optimal timing for surgery in terms of cost-effectiveness is unknown. A Markov model was used to compare the costs and outcomes of performing surgery after one, two, or three uncomplicated attacks in 60-year-old hypothetical cohorts. Transition state probabilities were assigned values using published data and expert opinion. Costs were estimated from Medicare reimbursement rates. Surgery after the third attack is cost saving, yielding more years of life and quality adjusted life years at a lower cost than the other two strategies. The results were not sensitive to many of the variables tested in the model or to changes made in the discount rate (0–5%). In conclusion, performing prophylactic resection after the third attack of diverticulitis is cost saving in comparison to resection performed after the first or second attacks and remains cost-effective during sensitivity analysis.

diverticulitiscost-effectivenessMarkov chainsdecision making

Copyright information

© Plenum Publishing Corporation 2002