Cost-Effectiveness Analysis of Splenectomy Versus Percutaneous Drainage for Splenic Abscess.

INTRODUCTION

Splenic abscesses are relatively rare but confer significant morbidity and mortality on affected patients. Current management paradigms range from antibiotic therapy alone to percutaneous drainage to definitive splenectomy. Although percutaneous catheter drainage (PCD) is less invasive and preserves splenic function, success rates are highly variable. We present a cost-effectiveness analysis of PCD versus upfront splenectomy for splenic abscesses.

METHODS

We performed a cost-effectiveness analysis using a base case of a stable adult inpatient with a splenic abscess treated with appropriate empiric antibiotics, without rupture or fistulation. Our comparison was PCD versus upfront splenectomy. We sourced outcome probabilities, health utilities, and costs from peer-reviewed literature. We report cost-effectiveness as an incremental cost-effectiveness ratio (ICER) defined as $ per quality-adjusted life-year. ICERs below a willingness-to-pay (WTP) threshold of $100,000/quality-adjusted life-year (QALY) are considered cost-effective for either intervention. We performed deterministic and probabilistic sensitivity analysis over all parameters and WTP thresholds.

RESULTS

Our base-case cost-effectiveness analysis found that splenectomy had an ICER of $365,674.25/QALY over PCD. The model was sensitive to PCD and PCD complication costs, splenectomy and splenectomy complication costs, salvage splenectomy rates after PCD, mortality rates after PCD or salvage splenectomy, and health utilities associated with PCD and abdominal drain placement. Splenectomy was cost-effective if our WTP threshold exceeded $380,000/QALY. Probabilistic sensitivity showed that drainage is cost-effective in most iterations.

CONCLUSIONS

At a WTP threshold of $100,000/QALY, upfront splenectomy was not more cost-effective than PCD. Our findings support considering drainage before splenectomy for stable patients with uncomplicated and accessible splenic abscesses.