Long-term outcomes and treatment cost estimates of flavonoids and polidocanol foam sclerotherapy for hemorrhoidal disease: a retrospective cohort study

Abstract Background Flavonoids and sclerotherapy are first-line treatments for hemorrhoidal disease (HD), but direct comparisons of long-term outcomes, patient satisfaction, and economic estimates are limited. Methods This single-center retrospective study included consecutive patients with symptomatic HD treated with flavonoids or sclerotherapy between May 2017 and February 2024, who completed a 24-month follow-up. Symptoms (bleeding, pain, prolapse) were scored on a 0–5 scale, with a total score calculated. The primary outcome was post-treatment bleeding and bleeding recurrence. Secondary outcomes included pain, prolapse, total symptom score, patient satisfaction (VAS), complications, compliance, and retreatment rates. Comparative and Kaplan–Meier analyses were performed, including Goligher II–III subgroups. Treatment-related acquisition costs were descriptively estimated. Results A total of 212 patients were included (138 flavonoids, 74 sclerotherapy), with comparable baseline characteristics. Significant symptom improvement from baseline was observed in both treatment groups, although patterns differed across individual symptoms. Lower post-treatment bleeding and total symptom scores were observed in the sclerotherapy group compared with the flavonoid group, both overall and in Goligher II–III patients ( p < 0.001), whereas pain reduction was greater with flavonoids. Patient satisfaction was higher after sclerotherapy ( p < 0.001). The median bleeding-free interval was 6 months in the flavonoid group and 12 months in the sclerotherapy group. No early complications were recorded after sclerotherapy. Flavonoid compliance was low (27.5%), whereas retreatment after sclerotherapy was required in 5.4% of cases. The estimated annual acquisition cost of flavonoid therapy was €245 per patient, whereas drug and disposable material costs for a single sclerotherapy session were approximately €20–25, excluding procedural delivery costs. Conclusions Both treatments were associated with significant symptom improvement. Different symptom-response patterns were observed between groups, with lower bleeding scores and longer bleeding-free intervals in patients undergoing sclerotherapy, whereas flavonoid-treated patients showed greater improvement in pain; these findings should be interpreted cautiously given the retrospective, non-randomized study design.