Purpose: Complex cryptoglandular anal fistula drives repeat operations and avoidable spend. Economic analyses rarely incorporate recurrence, and almost never cost the 'maintenance' strategy of repeated Seton. We performed a world-first, Australia-specific, recurrence-adjusted micro-costing comparing ligation of inter-sphincteric fistula tract (LIFT), endorectal advancement flap (ERAF), video-assisted anal fistula treatment (VAAFT) and Seton. Methodology: Hospital-provider micro-costing (2023–24 Australian dollars) across the public and private sector. Index episode costs included theatre, labour, consumables and accommodation; VAAFT capital was amortised across realistic volumes. Twelve‑month totals incorporated observed failure/recurrence and definitive re-intervention mixes for LIFT, ERAF and VAAFT, and four seton episodes/year for the seton strategy. Results: Observed 12‑month failure/recurrence was similar for definitive sphincter-sparing surgery (LIFT 36%, ERAF 38%, VAAFT 36%). Recurrence-adjusted 12‑month per‑patient totals (public/private) were: LIFT $1,828/$8,816; ERAF $2,156/$9,139; VAAFT $1,818–$2,965/$8,824–$10,476 depending on capital amortisation (high- vs low-volume). A Seton strategy requiring 3‑monthly repeat procedures cost $3,484/$20,200 per year, exceeding definitive options despite avoiding 'recurrence' by design. Conclusion: In Australia’s mixed funding system, recurrence costs drive convergence between definitive techniques, while repeated Seton is the costliest 'imperfect' pathway over 12 months. Solutions span colorectal practice and health policy: regionalised volume for capital-intensive platforms, ≥95% day-only pathways, standardised 4–6‑month surveillance with early salvage, and value-based funding (bundled episodes plus registry benchmarking) to reward durable healing and continence.