A Cost-effectiveness Analysis of Surgery, Endothermal Ablation, Ultrasound-guided Foam Sclerotherapy and Compression Stockings for Symptomatic Varicose Veins

Marsden, G.; Perry, Mark; Bradbury, Andrew W.; Hickey, N C; Kelley, Kate; Trender, Hazel; Wonderling, David; Davies, Alun H.

doi:10.1016/j.ejvs.2015.07.034

Cited by 44 publications

(37 citation statements)

References 26 publications

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“…This was owing to a lack of published randomized trials using RFA in patients with chronic venous ulcers. However, the mode of action and published technical success rates are comparable to those for EVLA34 35, leading some bodies (including the UK National Institute for Health and Care Excellence) to describe EVLA and RFA together as endovenous thermal ablation procedures36.…”

Section: Discussionmentioning

confidence: 99%

Cost‐effectiveness of treatments for superficial venous reflux in patients with chronic venous ulceration

et al. 2018

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BackgroundVenous leg ulcers impair quality of life significantly, with substantial costs to health services. The aim of this study was to estimate the cost‐effectiveness of interventional procedures alongside compression therapy versus compression therapy alone for the treatment of chronic venous leg ulceration.MethodsA Markov decision analytical model was developed. The main outcome measures were quality‐adjusted life‐years (QALYs) and lifetime costs per patient, from the perspective of the UK National Health Service at 2015 prices. Resource use included the initial procedures, compression therapy, primary care and outpatient consultations. The interventional procedures included superficial venous surgery, endothermal ablation and ultrasound‐guided foam sclerotherapy (UGFS). The study population was patients with a chronic venous ulcer who were eligible for either compression therapy or an interventional procedure. Data were obtained from systematic review and meta‐analysis of RCTs.ResultsSurgery gained 0·112 (95 per cent c.i. −0·011 to 0·213) QALYs compared with compression therapy alone, with a difference in lifetime costs of €−1330 (−3570 to 1262). Given the expected savings in community care, the procedure would pay for itself within 4 years. There was insufficient evidence regarding endothermal ablation and UGFS to draw conclusions.DiscussionThis modelling study found surgery to be more effective and less costly than compression therapy alone. Further RCT evidence is required for both endothermal ablation and UGFS.

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Section: Discussionmentioning

confidence: 99%

Cost‐effectiveness of treatments for superficial venous reflux in patients with chronic venous ulceration

et al. 2018

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“…Manche Autoren gehen so weit zu behaupten, alle Studien seien vergleichbar, es komme nur noch auf die Kosten der Therapie an [60].…”

Section: Ergebnisse Der Evla-behandlungunclassified

Treatment of varicose great saphenous veins with saphenofemoral junction insufficiency – what is the evidence? *

2020

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The results of studies on treatment of the great saphenous vein (GSV) with sapheno-femoral-junction (SFJ) insufficiency are unclear. Guidelines, however, recommend endovenous laser ablation (EVLA) and ultrasound-guided-foamsclerotherapy (UGFS) for symptomatic varicose large saphenous vein. There are numerous studies on GSV treatment but only a few randomized studies with a follow-up of two years and more. Meta-analyses in most instances included all studies and do not focus on studies with a follow-up of two years and longer. Methods A literature research in Pubmed used the keyword “great saphenous vein treatment”, “large saphenous vein treatment”, “varicose therapy” in conjunction with “randomized controlled trial”, “meta-analysis” and “systematic review”. Of 128 studies only 24 randomized controlled studies investigated the effect of High Ligation and Continuous Stripping (HL + CS), Endovenous Laser Ablation (EVLA), Radiofrequency Ablation (RFA), Liquid Sclerotherapy (LS), and Ultrasound-Guided-Foam-Sclerotherapy (UGFS) and a follow-up of two and more years. Study evaluation included “reflux”, “recurrence”, “therapy technique”, numbers of patients/legs treated, length of follow-up, and primary/secondary study endpoints. Results Most of these studies investigated surgical High Ligation and Continuous Stripping (HL + CS) with a follow-up of two years and more. This technique served a reference technique for other techniques in randomized controlled studies. However, there are major differences in techniques, mode of treatment, definitions, criteria for exclusion and inclusion, and study endpoints.The surgery study group included 1915 legs in 19 studies, the EVLA group 1047 legs in 12 studies and 240 legs in 3 studies with combined HL + EVLA treatment. RFA was used in 299 legs in 4 studies, UGFS in 661 legs in 5 studies, combined UGFS + HL in 39 legs and LS + HL in 92 legs in one study each.EVLA is associated with more reflux and recurrence when compared to HL + CS. RFA shows similar reflux and recurrence rates as surgery. In most studies UGFS and LS is followed by more reflux and recurrence when compared to surgery. Conclusion Due to heterogeneity of studies comparing study results of HL + CS, EVLA, RFA, LS and UGFS is not reliable. UIP or ECOP may form a commission to establish uniform, reliable and accepted study designs for varicose vein treatment to improve comparability of further randomized studies.

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“…6-week follow-up. If residual varicosities are still present and symptomatic, these will be treated by ambulatory foam [17].…”

Section: Re-treatments Of Residual Varicositiesmentioning

confidence: 99%

“…If there are no re-interventions or re-treatments, the index treatment is assumed to have been fully successful and the patient will be at full health for the whole 5-year period. It is assumed that 42% of patients requiring reintervention will be treated by UGFS, 46% by EVLA, and 12% by surgery [17,20]. As assumed in previous models, only one reintervention on the truncal vein would be considered per patient in the UK NHS [17,20].…”

Section: Re-interventions On the Truncal Veinmentioning

confidence: 99%

Cost-Effectiveness of Current and Emerging Treatments of Varicose Veins

et al. 2018

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At a threshold of £20,000/QALY, RFA was the treatment with highest median rank for net benefit, with MOCA second, EVLA third, HL/S fourth, CAE fifth, and CONS and UGFS sixth. Further evidence on effectiveness and health-related quality of life for MOCA and CAE is needed. At current prices, CAE is not a cost-effective option because it is costlier but has not been shown to be more effective than other options.

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A Cost-effectiveness Analysis of Surgery, Endothermal Ablation, Ultrasound-guided Foam Sclerotherapy and Compression Stockings for Symptomatic Varicose Veins

Abstract: Interventional treatment for VV is cost-effective in the UK NHS. Specifically, based on current data, ETA is the most cost-effective treatment in people for whom it is suitable. The results of this research were used to inform recommendations within the NICE guideline on VV.

Cited by 44 publications

References 26 publications

Cost‐effectiveness of treatments for superficial venous reflux in patients with chronic venous ulceration

Cost‐effectiveness of treatments for superficial venous reflux in patients with chronic venous ulceration

Treatment of varicose great saphenous veins with saphenofemoral junction insufficiency – what is the evidence? *

Cost-Effectiveness of Current and Emerging Treatments of Varicose Veins

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