Impact of Cost Sharing on Presentation in Acute Appendicitis or Diverticulitis

Investigators assessed the association between cost sharing and likelihood of uncomplicated presentation and surgical management of acute appendicitis or diverticulitis.

High patient cost sharing is associated with delayed and more complicated presentation of acute appendicitis or diverticulitis, according to a study published in JAMA Health Forum.

Researchers utilized Health Care Cost Institute insurance claims over a 5-year period to identify patients hospitalized for acute appendicitis or diverticulitis. Over 150,000 patients were included in the analysis that compared cost sharing with disease presentation. Cost sharing was defined as the total cost of the patient’s coinsurance, copay, and deductible.

The primary outcome was early, uncomplicated disease upon admission. Secondary outcomes were optimal management of surgery, defined as an appendectomy for appendicitis and the absence of a colostomy or ileostomy for diverticulitis, and a laparoscopic procedure.

In total, 151,852 patients were included in the analysis (47.6% women); 43.1% were diagnosed with appendicitis and 56.9% with acute diverticulitis. Median total cost sharing was $1725. Median cost sharing per episode of appendicitis was $1992 and $1524 per episode of acute diverticulitis.  

After adjustments for patient characteristics such as socioeconomic status, age, and geographical region, patients with higher cost sharing were associated with a lower likelihood of early, uncomplicated presentation of acute appendicitis or diverticulitis (odds ratio [OR], 0.63; 95% CI, 0.60-0.65). Similarly, patients with higher cost sharing were less likely to have a laparoscopic procedure or receive optimal surgical management.

Investigators acknowledge that variations exist within cost and quality of care among the hospitals patients were treated at. They were unable to adjust their analysis based on treatment facility.

While the study indicates a relationship rather than causality, the link between cost sharing, patient outcomes, and overall costs is an important one to consider. Investigators believe, “Understanding how cost sharing influences access to prompt, high-quality surgical care for common, costly, and highly morbid medical conditions is critical to informing public and private insurance plan design.”


Loehrer A, Leech M, Weiss J, et al. Association of cost sharing with delayed and complicated presentation of acute appendicitis or diverticulitis. JAMA Health Forum. 2021;2(9):e212324. doi: 10.1001/jamahealthforum.2021.2324

This article originally appeared on Gastroenterology Advisor