Chase D, Milne R; International Society of Technology Assessment in Health Care. Meeting.

Annu Meet Int Soc Technol Assess Health Care Int Soc Technol Assess Health Care Meet. 1999; 15: 132.

National Coordinating Centre for Health Technology Assessment, Wessex Institute for Health Research and Development, University of Southampton, United Kingdom.

OBJECTIVE/PURPOSE: In the UK, glyceryl trinitrate (GTN) ointment is currently an unlicensed treatment for chronic anal fissures. However, its use for this indication is rapidly increasing. Conventional treatment for this lateral sphinterotomy which has been associated with adverse side effects such as anal incontinence. The objective of this study was to model the cost-effectiveness of GTN for chronic anal fissures. METHODS: A systematic review and cost-effectiveness analysis. Based on a search of RCTs of GTN ointment for chronic anal fissues in MEDLINE (1995-October 1998), PreMEDLINE (search October 1998), HEALTHSTAR (1992-September 1998), EMBASE (1989-August 1998), NHS EED 91989 to August 1998), Cochrane library (Issue 4) and National Research Register (August 1998) and manufacturer's cost information. Methodological quality was assessed using the Critical Appraisal Skills Programme's guidelines. The cost per fissure healed was calculated. RESULTS: Three RCTs were identified which met the inclusion criteria. The largest of these trials, which also had the best methodological quality, generated a Number Needed to Treat of 2 i.e. 2 fissures would need to be treated with GTN ointment to heal 1 fissure (95% CI 1 to 3). The cost of GTN ointment is about Pounds 10 ($15). The cost of GTN ointment is about Pounds 9 ($13.50) for a 6 week course. The cost of lateral sphincterotomy ranges between Pounds 291 ($436.50) and Pounds 947 ($1420.50). Assuming that all fissures treated with lateral sphincterotomy heal, the lowest cost savings of GTN treatment per fissure healed are between about Pounds 113 ($169.50) and Pounds 136 ($204). CONCLUSIONS: Current evidence suggests that GTN ointment is a cost-effective treatment for chronic anal fissures. However, longer term research is required to assess the rate of recurrence and the incidence of future complications.

Publication Types:

• Meeting Abstracts

Keywords:

• Anal Canal
• Fissure in Ano
• Nitroglycerin
• Ointments
• Recurrence
• United States
• Wound Healing
• hsrmtgs

Other ID:

• HTX/20602452

UI: 102194141

From Meeting Abstracts