Bolkenstein HE, et al. - Considering the results of the DIRECT trial, a randomized clinical trial comparing conservative management with elective sigmoid resection in patients with recurrent diverticulitis or persistent complaints, indicated a higher quality of life following elective sigmoid resection, researchers investigated the cost-efficacy of surgical treatment at 1- and 5-year follow-up from a societal perspective. From the DIRECT trial, they derived clinical effectiveness and resource use and included 106 patients for this study. Of these, 50 were randomized to surgery and 56 to conservative treatment. They noted an incremental effect (QALY difference between groups) of 0.06 and 0.43 respectively, and an incremental cost (cost difference between groups) of €6,957 and €2,674, respectively, at 1- and 5-year follow-up. Surgery was identified as more expensive vs conservative treatment. These findings suggest that in patients with recurring diverticulitis or persistent complaints, elective sigmoid resection was cost-effective at 5-year follow-up.