To plug or not to plug: a cost-effectiveness analysis for complex anal fistula

Area of Science:

• Colorectal Surgery
• Surgical Innovation
• Health Economics

Background:

• Complex anal fistulas pose treatment challenges, with fistulotomy risking fecal incontinence.
• The anal fistula plug (AFP) offers a sphincter-preserving alternative for fistula healing.
• Evaluating cost-effectiveness of AFP versus endoanal advancement flap (EAAF) is crucial for complex anal fistulas.

Purpose of the Study:

• To compare the cost-effectiveness of the anal fistula plug (AFP) against the endoanal advancement flap (EAAF).
• To assess healing and complication rates for both sphincter-preserving procedures in complex anal fistulas.

Main Methods:

• A comparative study of 24 patients with complex anal fistulas: 12 treated with AFP (prospective) and 12 with EAAF (retrospective).
• Cost data collected per healthcare reporting standards.
• Cost-effectiveness analysis included extensive modeling of fistula healing rates.

Main Results:

• Similar demographics and fistula characteristics between AFP and EAAF cohorts.
• Fistula healing rates: 50% for AFP vs. 33% for EAAF.
• AFP use resulted in significant cost savings of $1,588 per healed fistula and reduced hospital stay by 1.5 days, confirmed by extensive modeling.

Conclusions:

• The anal fistula plug (AFP) is a cost-saving procedure for complex anal fistulas compared to the EAAF.
• AFP demonstrates comparable efficacy with significant economic advantages.