Background: Current UK National Health Service (NHS) guidelines recommend appendicectomy as gold standard treatment for acute uncomplicated appendicitis. However, an alternative non-surgical management involves administrating antibiotic-only therapy with significantly lower costs. Therefore, a UK-based cost-utility analysis (CUA) was performed to compare appendicectomy with an antibiotic-only treatment from an NHS perspective. Methods: This economic evaluation modelled health-outcome data using the ACTUAA (2021) prospective multicentre trial. The non-randomised control trial followed 318 patients given either antibiotic therapy or appendicectomy, with quality of life (QOL) assessed using the SF-12 questionnaires administered 1-year post-treatment. A CUA was conducted over a 1-year time horizon, measuring benefits in quality adjusted life years (QALYs) and costs in pound sterling using a propensity score-matched approach to control for selection based on observable factors. Results: The CUA produced an incremental cost-effectiveness ratio (ICER) of −GBP 23,278.51 (−EUR 27,227.80) per QALY. Therefore, for each QALY gained using antibiotic-only treatment instead of appendicectomy, an extra GBP 23,278.51 was saved. Additionally, two sensitivity analyses were conducted to account for post-operative or post-treatment complications. The antibiotic-only option remained dominant in both scenarios. Conclusion: While the results do not rely on a randomized sample, the analysis based on a 1-year follow-up suggested that antibiotics were largely more cost-effective than appendicectomy and led to improved QOL outcomes for patients. The ICER value of −GBP 23,278.51 demonstrates that the NHS must give further consideration to the current gold standard treatment in acute uncomplicated appendicitis.

Background: The UK National Health Service (NHS) propose the use of oxybutynin prior to onabotulinumtoxinA (Botox) in the management of overactive bladder syndrome (OAB). Oxybutynin is costly and associated with poor adherence, which may not occur with Botox. We conducted a cost-utility analysis (CUA) to compare the medications. Methods: we compared the two treatments in quality-adjusted life years (QALYS), through the NHS’s perspective. Costs were obtained from UK-based sources and were discounted. Total costs were determined by adding the treatment cost and management cost for complications on each branch. A 12-month time frame was used to model the data into a decision tree. Results: Our results found that using Botox first-line had greater cost utility than oxybutynin. The health net benefit calculation showed an increase in 0.22 QALYs when Botox was used first-line. Botox also had greater cost-effectiveness, with the exception of pediatric patients with an ICER of £42,272.14, which is above the NICE threshold of £30,000. Conclusion: Botox was found to be more cost-effective than antimuscarinics in the management of OAB in adults, however less cost-effective in younger patients. This predicates the need for further research to ascertain the age at which Botox becomes cost-effective in the management of OAB.

Aim: While surgeons and robotic companies are key stakeholders involved in the adoption of Robotic Surgery (RS), the public's role is often overlooked. However, given that patients hold ultimate power over their healthcare decisions, public acceptance of RS is crucial. This study aims to identify public understanding, opinions and misconceptions on RS and present solutions to facilitate its wider integration. Method: An online questionnaire distributed via social media platforms between February and May 2021 identified the views of UK adults on RS. The data was evaluated using thematic analysis, descriptive statistics, and statistical analysis. Statistical differences in age, gender, education level, and presence in the medical field were also sought. Results: 263 responses were obtained, with 216 (82.1%) analysed. Demographic differences provided significantly different results. Participants were relatively uninformed about RS, with a median knowledge score of 4.00(2.00–6.00) on a 10-point likert scale. Fears surrounding increased risk, reduced precision and technological failure were identified, alongside misconceptions on what RS entails, including it being autonomous. However, providing factual information in the survey about RS statistically increased participant comfort (p=<0.0001). Most (61.8%) participants believed robot manufacturers were responsible for malfunctions, but doctors were held accountable more by older, less educated, and non-medical participants. Conclusions: This study highlights the role of negative and inaccurate public perceptions surrounding RS in impeding its widespread adoption. Greater emphasis must be placed on patient education in RS to mitigate misconceptions and ensure greater diffusion of its benefits