Direct and indirect costs for anal fistula in Sweden

• Total mean discounted costs for patients with anal fistula were €5561 per patient where approximately 80% were direct costs.
• Almost 40% of the patients had more than one surgery and on average these patients underwent over four surgeries.
• Health care resources and sick leave are especially high for patients experiencing multiple surgeries.

IntroductionAnal fistula is an abnormal tract with an external and internal opening that cause leakage, discomfort, and occasionally pain. Surgery is standard treatment, but recurrence and anal incontinence is common. The objective of the study was to analyze resource use, costs and sick leave for newly diagnosed patients with anal fistula in Sweden.MethodsThe study was based on register data from linkages between Swedish population-based registers including patients treated for anal fistula in Västra Götaland County, Sweden. Health care resource use, costs and sick leave were estimated.ResultsThe sample included 362 patients of which 27% had no surgery, 37% had one surgery and 36% had multiple surgeries. Patients with multiple surgeries underwent over four surgeries on average. Approximately 67% of the contacts occurred during the first year after diagnosis. Estimated mean sick leave was 10.4 full-time equivalent days per patient. Total discounted costs were €5,561 per patient where approximately 80% were direct costs.DiscussionTo our knowledge this is the first study of resource use, costs and sick leave related to anal fistulas. The study indicates that anal fistula is a condition that is costly for society and that the burden of anal fistula in terms of health care resources and sick leave is especially high for patients experiencing multiple surgeries.ConclusionAnal fistula is a condition that is costly for society and there is an unmet need for the group of patients with multiple surgeries to find appropriate treatment interventions.