Economic evaluation of Longo vs Ferguson technıque in haemorrhoid treatment

Yıl 2004, Cilt: 9 Sayı: 2, 63 - 71, 14.01.2013

Yousef Thwayeb Gonzalez Hermoso Abásolo Alessón

Öz

Abstract. 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  3^rd and 4^th 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.

Keywords: Longo Technigue, Ferguson technique, haemorrhoid treatment

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