Hemorrhoid Banding: A Cost-Effectiveness Analysis

Abstract

BACKGROUND: Hemorrhoid banding is an established treatment for symptomatic internal hemorrhoids with proven efficacy, low cost, and limited discomfort. Although the costs and quality of life following individual banding treatments have been investigated, little is known about cumulative cost and quality of life from sequential banding therapy or how these cumulative costs compare to surgical therapy. OBJECTIVE: This study aimed to determine the cost-effectiveness of sequential hemorrhoid banding therapy. DESIGN: A retrospective review of historic banding treatment patterns was performed. Cost estimates and quality-of-life predictions were applied to observed treatment patterns in a decision-analytic cost-effectiveness model to compare sequential banding therapy with hypothetical surgical intervention. SETTING: A retrospective billing record review for patients treated in a colorectal specialty clinic between 2012 and 2017 was performed. PATIENTS: Patients initially treated with banding therapy for symptomatic internal hemorrhoids were included. MAIN OUTCOME MEASURE: The primary outcomes measured were hemorrhoid banding treatment patterns, cost-effectiveness, and net monetary benefit. RESULTS: Treatment of 2026 patients undergoing hemorrhoid banding identified 94% resolution with sequential banding and 6% requiring delayed surgical intervention. Average cumulative estimated cost for banding therapy was $723 (range, $382–$4430) per patient with an average quality-of-life deficit of –0.00234 (range, –0.00064 to –0.02638) quality-adjusted life-years. Estimates for hypothetical hemorrhoid artery ligation, stapled hemorrhoidopexy, or surgical hemorrhoidectomy found significantly higher cost (3.15×, 4.39×, and 2.75× more expensive) and a significantly worse quality-of-life deficit (1.55×, 5.64×, and 9.45× worse). For patients with persistent disease, continued sequential banding remained the dominant cost-effective therapy. LIMITATIONS: This cost-effectiveness model relies on a retrospective review of billing records with estimated cost and quality of life. CONCLUSIONS: Hemorrhoid banding is a valuable treatment modality with favorable cost-effectiveness. The majority of patients selected for banding find resolution without surgery. For patients with persistent disease, further banding procedures remain cost-effective compared with delayed surgical therapy. See Video Abstract at http://links.lww.com/DCR/A982. BANDA HEMORROIDAL: UN ANÁLISIS DE COSTO-EFECTIVIDAD ANTECEDENTES: La banda para hemorroides es un tratamiento establecido para las hemorroides internas sintomáticas con eficacia comprobada, bajo costo y malestar limitado. Si bien se han investigado los costos y la calidad de vida después de los tratamientos de bandas individuales, se sabe poco sobre el costo acumulativo y la calidad de vida de la terapia de bandas secuencial o cómo estos costos acumulativos se comparan con la terapia quirúrgica. OBJETIVO: Determinar el costo-efectividad de la terapia secuencial de bandas hemorroidales. DISEÑO: Se realizó una revisión retrospectiva de la historia de los patrones de tratamiento con bandas. Las estimaciones de costos y las predicciones de la calidad de vida se aplicaron a los patrones de tratamiento observados en un modelo analítico de costo-efectividad para comparar la terapia de bandas secuencial con la intervención quirúrgica hipotética. AJUSTE: Revisión retrospectiva de los registros de facturación de los pacientes tratados en una clínica de especialidad colorrectal entre 2012 y 2017. PACIENTES: Pacientes tratados inicialmente con terapia de bandas para hemorroides internas sintomáticas. PRINCIPALES MEDIDAS DE RESULTADO: Patrones de tratamiento con bandas de hemorroides, costo-efectividad y beneficio monetario neto. RESULTADOS: El tratamiento de 2026 pacientes con bandas identificó una resolución del 94% con bandas secuenciales y el 6% requirió una intervención quirúrgica tardía. El costo promedio acumulado estimado para la terapia de banda fue de $ 723 (Rango: $382–$4430) por paciente con un déficit de calidad de vida promedio de –0.00234 (Rango: –0.00064 a –0.02638) años de vida ajustados por calidad. Las estimaciones para la hipotética ligadura de la arteria hemorroidal, la hemorroidopexia con grapas o la hemorroidectomía quirúrgica encontraron un costo significativamente mayor (3.15×, 4.39×, 2.75× más caro) y un déficit de la calidad de vida significativamente peor (1.55×, 5.64×, 9.45× peor). Para los pacientes con enfermedad persistente, la colocación de bandas secuenciales continuas siguió siendo la terapia rentable dominante. LIMITACIONES: Este modelo de costo-efectividad se basa en una revisión retrospectiva de los registros de facturación con el costo y la calidad de vida estimados. CONCLUSIONES: Las bandas de hemorroides son una valiosa modalidad de tratamiento con una favorable relación costo-efectividad. La mayoría de los pacientes seleccionados para terapia con bandas encuentran resolución sin cirugía. Para los pacientes con enfermedad persistente, los procedimientos de colocación de bandas adicionales siguen siendo rentables en comparación con el tratamiento quirúrgico tardío. Vea el Resumen del video en http://links.lww.com/DCR/A982.

Rubber band ligation of hemorrhoids: is the procedure effective for the immunocompromised, hemophiliacs and pregnant women?

“…As we always placed a maximum of 4 bands/session, to avoid strictures, repeated sessions were required, particularly in hemophiliac patients (up to 6 vs. 4 in controls). The success rate of RBL ranged between 79% and 91.8% [ 13 , 23 ], while repeated banding sessions showed an efficacy of up to 94% [ 24 ]. In our series, all patients experienced successful eradication and remained asymptomatic for at least the 1-year follow up.…”

Review of American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Hemorrhoids

“…Rubber band ligation is very effective, cost-efficient, well tolerated, has a low complication rate, and should be considered appropriate initial treatment for stage I to III internal hemorrhoids. 3,4 Although surgical treatment is more effective than rubber band ligation, it is also associated with a higher complication rate and is typically reserved for those with failed conservative measures and grade IV hemorrhoids. Patients with excisional hemorrhoidectomy had better resolution of symptoms, less need for future interventions, and better continence compared with stapled hemorrhoidopexy.…”

“…Rubber band ligation has been shown to be superior to sclerotherapy or infrared coagulation with a high success rate for grade I, II, and III hemorrhoids. Rubber band ligation is very effective, cost-efficient, well tolerated, has a low complication rate, and should be considered appropriate initial treatment for stage I to III internal hemorrhoids . Although surgical treatment is more effective than rubber band ligation, it is also associated with a higher complication rate and is typically reserved for those with failed conservative measures and grade IV hemorrhoids.…”

A comparative study of rubber band ligation versus BANANA-Clip in grade 1 to 3 internal hemorrhoids

“…Furthermore, it allows the destruction of internal hemorrhoids, just as in the standard ligature and excision method of hemorrhoidectomy [3]. RBL is cost-effective compared with hemorrhoidal artery ligation, stapled hemorrhoidopexy, or surgical hemorrhoidectomy [8] and doesn't alter anorectal function [9]. For this reason, RBL is recommended as the initial mode of therapy for grades 1 to 3 hemorrhoids.…”