Use of the Ring Wound Protector in Open Appendectomy: A Model-Based Cost-Utility Analysis
Boonying Siribumrungwong, Kamolpat Chaiyakittisopon, Suphakarn Techapongsatorn, ภัคพล สุขวิบูลย์, อมฤต ตาลเศวต*
Department of Surgery, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, 681 Samsen Road, Dusit District, Bangkok 10300, Thailand; Phone: +66-2-2443282, Fax: +66-2-2443281; Email:
Objective: To evaluate cost-effectiveness of ring wound protector (RWP) used in open appendectomy.
Materials and Methods: The present study was a decision-tree-based analysis. Model inputs, including costs, utilities, and probabilities of surgical site infection (SSI), were retrieved from the previous studies. The incremental cost-effectiveness ratio (ICER) represented the cost of one additional quality-adjusted life day (QALD). This ratio was calculated by dividing the incremental cost [Thai Baht (THB)] by the incremental QALD. One-way sensitivity analyses were performed by varying each input parameter to see how ICER change. Monte-Carlo simulation with 5,000 replications was used to estimate probabilistic ICER and construct the acceptability curve, demonstrating how the probability of being cost-effective changed
when the willingness-to-pay (WTP) threshold was shifted.
Results: The deterministic ICER of 64,630.78 THB/QALD did not favor RWP use compared with the WTP threshold of 10,000 THB/QALD. However, if the threshold was shifted to 100,000 THB/QALD, it would yield approximately 75% probability of being cost-effective from RWP. Threshold analysis indicated that RWP should cost 281, 301, and 661 THB to be cost-effective at the threshold of 500, 1,000, and 10,000 THB/QALD, respectively.
Conclusion: Routine RWP use might not be cost-effective when QALD is the outcome of interest. Based on the results from the present study, policy-makers could be informed that the adoption of this health technology might not be suitable.
วารสารจดหมายเหตุทางการแพทย์ ปี 2564, December ปีที่: 104 ฉบับที่ 12 หน้า 1971-1976
Appendectomy, Cost-utility analysis, Ring wound protector, Decision tree model