The place of mini-invasive Transanal-Hemorrhoidal-Dearterialisation and Rectopexy technique in the treatment of hemorrhoidal disease, an evaluation from cost-effectiveness point of view

Background. Choosing the most suitable treatment for Hemorrhoidal Disease (HD) still poses problems for both patients and doctors. THD-RAR although it has proven its superiority regarding postoperative complications, length of hospital stay, return to daily activity compared to Hemorrhoidectomy (HE), it still has a low rate of less than 10% in our hospital, the main causative factor being the increased cost of consumables. Our aim is to analyze the veracity of this factor. Methods. We performed a case-control study in the period 2009-2022 and we evaluated two groups of 50 patients, operated by the THD-RAR method and HE respectively. We had as Main Objective the comparison of average hospitalization costs and as Secondary Objectives the evaluation of postoperative hospitalization, complications, recurrences, the influence on the final cost of social costs. Results. Financially, the elderly had less accessibility to THD-RAR. Internal hemorrhoids predominated in the THD-RAR-group and associated ones in the HE-group (64% and 48%, respectively; p<0.001). Bleeding was the predominant symptom in THD-RAR-group versus prolapse in the HE-group. The mean operation time was longer in THD-RAR compared to HE (48 and 56 min respectively; not significant). The significantly longer postoperative hospital stay in the HE-group compared to the THD-RAR-group (2.52 versus 1.74 days; p<0.001), obviously influenced the hospitalization expenses (834 versus 485 EUR; p<0,001). Thus, although the expenses with the operation were higher for THD-RAR compared to HE, in the end summing up the hospitalization expenses and the social expenses, the difference tilted in detriment of HE (277 EUR). Conclusion. Our study shows that if we subtract from the amortization expenses, the savings made from hospitalization expenses and social expenses, then THD-RAR-HE balance will be in favor of THD. THDRAR must take its place both in the hospitals' own therapeutic protocols and in the national guidelines, being a cost-effective method.