Is stapled haemorrhoidopexy cost-effective and even cost-saving in UK clinicalpractice?: OP41

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Aim:Despite documented advantages, theprovision of stapled haemorrhoidopexy (SH) in the UK remains disparate. A full economic evaluation was undertaken to establish its cost-effectiveness compared to conventional haemorrhoidectomy (CH).Method:A cost-utility analysis was undertaken to compare SH with CH, including aprobabilistic, cohort-based decision tree within a 1-year time-horizon. Costs were analyzed from a hospital and NHS perspective. Utility was calculated in terms of Quality Adjusted Life Years (QALYs). Sensitivity analyses were performed to determine how the incremental cost effective ratio (ICER) varied with recurrentprolapse and need for surgical re-intervention.Results:A shorter operating theatre and decreased hospital stay following SH led to a cost saving of £27/procedure at the hospital level. From the NHS perspective, the total treatment costs inclusive of the cost of recurrentprolapse, led to an incremental cost of £33/procedure after 1 year. Calculation of QALYs showed an incremental QALY of 0.0076 and an ICER of £4,316, indicating high costeffectiveness. Sensitivity analysis of variations in clinicalpractice showed that SH can become a costsavingprocedure.Conclusion:Stapled haemorrhoidopexy is a cost-effectiveprocedure compared to CH and can even be cost-saving in UK clinicalpractice. This economic analysis supports its widespread UK implementation.

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