OBJECTIVES: Surgical management of Haemorrhoidal Disease includes Milligan-Morgan (MM) haemorrhoidectomy and Stapled Haemorrhoidopexy (PPH). Scope of work was to compare HTA Reports for PPH vs. MM (especially cost and budget impact analyses) for two Italian Regions: Lombardia and Toscana. METHODS: Literature search; identification of the surgical course (intervention, hospital admission) and global course (clinical evaluation, surgical phase, follow-up) at the local hospital level; micro-costing for PPH vs. MM at 3 hospitals per Region; comparison of direct medical costs, reimbursement tariffs and budgetary impact in 2008 Euro values. RESULTS: PPH surgical pattern generates costs to Hospitals of €2,306 and €2,177/case, respectively in Lombardia and Toscana; MM surgery costs are €1558 and €1277/case, respectively. Higher unitary costs of personnel and operating theatre in Lombardia drive higher surgical intervention costs, irrespective of procedure type. Whereas hospital admission costs were similar for PPH (€698 vs €638), the gap between Lombardia and Toscana widens for MM hospitalization costs (€812 vs €638), because of longer length of stay in full admission setting. The Lombardia DRG158 tariff (€1209) is not sufficient to recap costs of both alternatives, whilst the Toscana tariff (€1400) is remunerative only for MM, but not when applying higher levels of operating theatre unit cost. The global course generates costs of €2532 (PPH-Lombardia) and €2400 (PPH-Toscana) vs €1781 (MM-Toscana) and €1527 (MM-Toscana). Sensitivity analyses on literature data confirmed the robustness of basecase results. Budget impact analysis, based on regional statistics for haemorrhoidal surgery and suggested extra-tariffs for PPH, estimated the need for additional funding ranging 1.7%-16% for Lombardia and 2.2%-20.4% for Toscana, over the current Regional expenditure. CONCLUSIONS: Analysis of management courses showed the inadequacy of current regional funding for PPH and MM. Current regionalization of the Italian NHS prompts for implementation of HTA at the Regional level.