Aim To undertake full economic evaluation of stapledhemorrhoidopexy (PPH) to establish its cost-effectivenessand investigate whether PPH can become cost-savingcompared to conventional excisional hemorrhoidectomy(CH).Methods A cost–utility analysis in hospital and health caresystem (UK) was undertaken using a probabilistic, cohortbaseddecision tree to compare the use of PPH with CH.Sensitivity analyses allowed showing outcomes in regardto the variations in clinical practice of PPH procedure.The participants were patients undergoing initial surgicaltreatment of third and fourth degree hemorrhoids withina 1-year time-horizon. Data on clinical effectiveness wereobtained from a systematic review of the literature. Mainoutcome measures were the cost per procedure at thehospital level, total direct costs from the health care systemperspective, quality adjusted life years (QALY) gainedand incremental cost per QALY gained.Results A decrease in operating theater time and hospitalstay associated with PPH led to a cost saving compared toCH of GBP 27 (US $43.11, €30.50) per procedure at the hospitallevel and to an incremental cost of GBP 33 (US $52.68,€37.29) after one year from the societal perspective. Calculationof QALYs induced an incremental QALY of 0.0076and showed an incremental cost-effective ratio (ICER) ofGBP 4316 (US $6890.47, €4878.37). Taking into considerationrecent literature on clinical outcomes, PPH becomescost saving compared to CH for the health care system.Conclusions PPH is a cost-effective procedure with anICER of GBP 4136 and it seems that an innovative surgicalprocedure could be cost saving in routine clinical practice.
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