Economic evaluation of Longo vs Ferguson technýque in haemorrhoid treatment

We performed a pragmatic economic evaluation of a randomized controlled trial comparing two alternative surgical techniques for haemorrhoid treatment: Longo vs Ferguson. The primary economic evaluation framework employed was cost-utility analysis. 40 patients with 3rd and 4th degree haemorrhoids were randomly assigned to either technique (20 each). Cost data were measured within and out with the trial, then were combined with quality-adjusted life years (QALYs) to obtain cost-per-QALY ratios. Mean cost of Longo technique was €3,637.49 compared with €4,509.36 for Ferguson technique. The extra €871.87 in Ferguson group was mainly indirect costs. At 2 years post-intervention, Ferguson-treated patients gained a mean 1.8294 QALYs while Longo-treated patients gained a mean 1.5706 QALYs. This difference was not statistically significant (P>0.05) so we opted for analysis of cost minimization. We had three cases of anal fissures, twelve tenesmus, five recurrences and 80 % of the patients with fourth degree haemorrhoids were unsatisfied, complained of persistent skin tags and requested excision. The trade-offs between each procedure´s attributes providing monetary estimates of benefit for both techniques (trade-offs -willingness to pay €2,703; Longo and €2,395.5 Ferguson), showed that the costs were significantly higher than the benefit in both. At three months all favoured Longo procedure, but at 3 years only third degree patients did so, while fourth degree patients favoured Ferguson procedure. The low benefit perceived in both procedures may be attributed to Health Service funding.