Cost-effectiveness of routine imaging of suspected appendicitis.

Introduction The misdiagnosis of appendicitis and consequent removal of a normal appendix occurs in one in five patients in the UK. On the contrary, in healthcare systems with routine cross-sectional imaging of suspected appendicitis, the negative appendicectomy rate is around 5%. If we could reduce the rate in the UK to similar numbers, would this be cost effective? This study aimed to calculate the financial impact of negative appendicectomy at the Queen Alexandra Hospital and to explore whether a policy of routine imaging of such patients could reduce hospital costs. Materials and methods We performed a retrospective analysis of all appendicectomies over a 1-year period at our institution. Data were extracted on outcomes including appendix histology, operative time and length of stay to calculate the negative appendicectomy rate and to analyse costs. Results A total of 531 patients over 5 years of age had an appendicectomy. The negative appendicectomy rate was 22% (115/531). The additional financial costs of negative appendicectomy to the hospital during this period were £270,861. Universal imaging of all patients with right iliac fossa pain that could result in a 5% negative appendicectomy rate would cost between £67,200 and £165,600 per year but could save £33,896 (magnetic resonance imaging), £105,896 (computed tomography) or £132,296 (ultrasound) depending on imaging modality used. Conclusions Negative appendicectomy is still too frequent and results in additional financial burden to the health service. Routine imaging of patients with suspected appendicitis would not only reduce the negative appendicectomy rate but could lead to cost savings and a better service for our patients.

Serum proteins in hepatic amoebiasis.

Serum proteins were estimated in two patient groups, namely (i) 20 cases with proven ameobic liver abscess and (ii) 12 cases with hepatic amoebiasis without demonstrable pus, commonly referred to by the misnomer 'ameobic hepatitis'. In amoebic liver abscess a fall in albumin and an increase in alpha 2 and gamma globulin results in a serum protein pattern somewhat different from that in hepatic amoebiasis without demonstrable pus, where an elevation in gamma globulin was infrequent. Post-therapy serum protein estimations revealed that, irrespective of the presence or absence of pus, a rising gamma globulin level in hepatic amoebiasis may be of prognostic significance and post-treatment surveillance would be necessary in patients showing this type of response.