The Cost of Imperfection: Recurrence-Adjusted Costs of Sphincter-Preserving Procedures for Complex Anal Fistula in Australia.
Treatment failure rates were similar across sphincter-preserving anal fistula procedures at 12 months.
The Cost of Imperfection: Recurrence-Adjusted Costs of Sphincter-Preserving Procedures for Complex Anal Fistula in Australia.
Complex cryptoglandular anal fistula is frequently complicated by treatment failure, repeat intervention and ongoing healthcare use.
This study compared 12-month pathway costs for ligation of the inter-sphincteric fistula tract (LIFT), endorectal advancement flap (endorectal advancement flap), video-assisted anal fistula treatment (video-assisted anal fistula treatment) and non-definitive seton management in Australia.
Failure rates and re-intervention pathways were derived from a prospectively maintained cohort treated within a single colorectal surgical network (LIFT n = 88; endorectal advancement flap n = 16; video-assisted anal fistula treatment n = 22).
About one in three definitive fistula repairs failed within a year, similar across techniques.
Pathway costs incorporating treatment failure were AUD 1846/8858 for LIFT, AUD 2161/9164 for endorectal advancement flap, and AUD 1937-2968/8870-10 499 for video-assisted anal fistula treatment in public/private hospitals, depending on case volume.
Seton management cost AUD 871-3484/5050-20 200 per year, depending on operative frequency.
Incorporating treatment failure narrowed cost differences between definitive sphincter-preserving techniques. Non-definitive seton costs were frequency-dependent.
Local case volume, admission pathway, and failure burden should inform service planning and video-assisted anal fistula treatment adoption.