Tu1062 Cost-Effectiveness of Stapled Hemorrhoidopexy: A Randomized Comparison With Ferguson Closed Diathermy Hemorrhoidectomy
| Autor: | Norman Binnie, Catherine Bryant, Kenneth Campbell, Wilson S. Hendry, Mohamed A. Thaha, Syed A Kazmi, Robert Steele, Andrew Walker |
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| Rok vydání: | 2012 |
| Předmět: |
medicine.medical_specialty
Randomization Hepatology Cost effectiveness business.industry medicine.medical_treatment Gastroenterology Diathermy medicine.disease Ferguson hemorrhoidectomy Surgery law.invention Hemorrhoids Quality of life Randomized controlled trial law Stapled hemorrhoidopexy medicine business |
| Zdroj: | Gastroenterology. 142:S-735 |
| ISSN: | 0016-5085 |
| DOI: | 10.1016/s0016-5085(12)62856-x |
| Popis: | Background: Our 2-armed multi-centre randomized controlled trial (RCT) reported a significantly reduced postoperative pain and higher patient acceptability following stapled hemorrhoidopexy (SH) but without similar advantage for post-treatment residual prolapse or retreatment rates. In this parallel health economics study, we aimed to determine the costeffectiveness of SH from a hospital perspective when compared with Ferguson hemorrhoidectomy (FH). Methods: After informed consent and randomization, 182-patients with symptomatic hemorrhoids (grades II, III, IV) underwent either SH (91) or FH and were followed for up to 1-year (6, 12, 24, 48-weeks) after operation. All health-care resource costs for the initial treatment and follow-up events were recorded prospectively at individual patient level. Quality of life (QoL) was assessed at baseline, and at follow-up using SF36v2 questionnaire and QALY's generated using SF-6D algorithm. An incremental cost of avoiding a recurrence was calculated along with an incremental cost per QALY for SH. Differences between groups were based on linear regression adjusting for baseline scores. Results: At 1-year follow-up, a total of 18 (20.7%) patients in SH group had clinical recurrence compared to 9 (11.5%) in FH group (OR= 2, 95% CI 0.8405-4.7593). 12-SH patients required retreatment for residual symptoms compared to 5 in FH group. Re-treatment for residual prolapse was significantly higher in SH group (8 vs. 1; SH vs. FH; p=0.027 X2-test). At 1year the mean difference in QALY's was non-significant (0.7877 vs. 0.7938, SH vs. FH; p= 0.877 MWU-test). The extra mean cost (£312.51) incurred for SH was due to the additional cost for the single use custom-designed circular stapler. The cost per unit of successful outcome was less in FH group compared to SH group (£770.75 vs. 1184.45; FH vs. SH). Conclusions: Stapled hemorrhoidopexy offers significant advantages of lower post-operative pain but is associated with significantly higher residual prolapse rates requiring re-operation. The mean cost of stapled hemorrhoidopexy was higher compared to Ferguson hemorrhoidectomy and this was largely explained by the cost of the single use stapler. Furthermore, the study failed to demonstrate any significant cost-effectiveness advantage for stapled hemorrhoidopexy when compared to Ferguson hemorrhoidectomy. |
| Databáze: | OpenAIRE |
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