Modelling the economic impact of managing a chronic anal fissure with a proprietary formulation of nitroglycerin (Rectogesic) compared to lateral internal sphincterotomy in the United Kingdom

Int J Colorectal Dis. 2002 Jul;17(4):259-67. doi: 10.1007/s00384-001-0371-6. Epub 2002 Jan 9.


Background and aims: This study estimated the economic impact of using a proprietary formulation of 0.2% nitroglycerin (GTN) ointment (Rectogesic) compared with lateral internal sphincterotomy in the treatment of a chronic anal fissure in the United Kingdom (UK), from the perspective of the National Health Service (NHS).

Patients and methods: Clinical and surgical outcomes attributable to managing a chronic anal fissure were obtained from published literature, supplemented with information about resource utilisation derived from interviews with a panel of colorectal surgeons and general practitioners. Using this information, a decision tree modelling the management of a chronic anal fissure by a colorectal surgeon was constructed. Unit resource costs at 1999/2000 prices were applied to the resource utilisation estimates in the model to estimate the expected NHS cost of managing a chronic anal fissure. Consensus on the information contained within the model was reached at a meeting with an expert panel comprising five of the interviewees and one other colorectal surgeon.

Results: The expected NHS cost of a colorectal surgeon initially managing a chronic anal fissure with GTN was estimated to be pound616, compared to pound840 when a lateral internal sphincterotomy is the first-line treatment. Moreover, the expected probability of successful healing following initial treatment with either intervention is 99-100%, taking into account all subsequent treatments.

Conclusion: The initial use of GTN compared to lateral internal sphincterotomy to treat a chronic anal fissure affords a potential cost reduction to the NHS of pound224 per patient without any loss in effectiveness. Hence, GTN is potentially a cost-effective first-line treatment strategy for the management of a chronic anal fissure.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anal Canal / surgery*
  • Cost Control
  • Decision Trees*
  • Fissure in Ano / economics*
  • Fissure in Ano / therapy
  • Health Care Costs / statistics & numerical data
  • Health Resources / statistics & numerical data
  • Humans
  • Models, Economic
  • Nitroglycerin / economics*
  • Nitroglycerin / therapeutic use
  • State Medicine / economics*
  • United Kingdom
  • Vasodilator Agents / economics*
  • Vasodilator Agents / therapeutic use


  • Vasodilator Agents
  • Nitroglycerin