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. 2018 Sep;2(3):271-280.
doi: 10.1007/s41669-017-0052-1.

Cost Effectiveness of Stapled Haemorrhoidopexy and Traditional Excisional Surgery for the Treatment of Haemorrhoidal Disease

Mary M Kilonzo  1 , Steven R Brown  2 , Hanne Bruhn  3 , Jonathan A Cook  4 , Jemma Hudson  5 , John Norrie  6 , Angus J M Watson  7 , Jessica Wood  5
Affiliations

Cost Effectiveness of Stapled Haemorrhoidopexy and Traditional Excisional Surgery for the Treatment of Haemorrhoidal Disease

Mary M Kilonzo et al. Pharmacoecon Open. 2018 Sep.

Abstract

Objective: Our objective was to compare the cost effectiveness of stapled haemorrhoidopexy (SH) and traditional haemorrhoidectomy (TH) in the treatment of grade II-IV haemorrhoidal disease from the perspective of the UK national health service.

Methods: An economic evaluation was conducted alongside an open, two-arm, parallel-group, pragmatic, multicentre, randomised controlled trial conducted in several hospitals in the UK. Patients were randomised into either SH or TH surgery between January 2011 and August 2014 and were followed up for 24 months. Intervention and subsequent resource use data were collected using case review forms and questionnaires. Benefits were collected using the EQ-5D-3L (EuroQoL-five dimensions-three levels) instrument. The primary economic outcome was incremental cost measured in pounds (£), year 2016 values, relative to the incremental benefit, which was estimated using quality-adjusted life-years (QALYs). Cost and benefits accrued in the second year were discounted at 3.5%. The base-case analysis was based on imputed data. Uncertainty was explored using univariate sensitivity analyses.

Results: Participants (n = 777) were randomised to SH (n = 389) or TH (n = 388). The mean cost of SH was £337 (95% confidence interval [CI] 251-423) higher than that of TH and the mean QALYs were -0.070 (95% CI -0.127 to -0.011) lower than for TH. The base-case cost-utility analysis indicated that SH has zero probability of being cost effective at both the £20,000 and the £30,000 threshold. Results from the sensitivity analyses were similar to those from the base-case analysis.

Conclusions: The evidence suggests that, on average, the total mean costs over the 24-month follow-up period were significantly higher for the SH arm than for the TH arm. The QALYs were also, on average, significantly lower for the SH arm. These results were supported by the sensitivity analyses. Therefore, in terms of cost effectiveness, TH is a superior surgical treatment for the management of grade II-IV haemorrhoids when compared with SH.

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Conflict of interest statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Conflicts of interest

Mary Kilonzo, Steven Brown, Hanne Bruhn, Jonathan Cook, Jemma Hudson, Jessica Wood and Angus Watson have no conflicts. John Norrie has received personal fees from the NIHR HTA and Efficacy and Mechanism Evaluation (EME) Editorial Board outside the submitted work.

Ethical approval

The study was approved by the North of Scotland Research Ethics Committee on 18 June 2010 (reference number 10/20802/17).

Informed consent

Informed consent was obtained from all individual participants included in the study.

Figures

Fig. 1
Fig. 1
Cost effectiveness acceptability curve showing the probability that SH and TH is cost effective giving the different values of willingness to pay thresholds
Fig. 2
Fig. 2
Cost effectiveness scatter plot illustrating the distribution of differences in cost and QALY
See this image and copyright information in PMC

References

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