Cost-effectiveness analysis of five procedures for great saphenous vein reflux in a Norwegian healthcare setting or societal setting

Abstract

Objective:The aim of this work was to estimate cost-effectiveness of five common procedures for varicose vein surgery (high ligation and stripping, radiofrequency ablation, endovenous laser ablation, steam vein sclerosis and cyanoacrylate glue) in a Norwegian setting from both a societal and a healthcare payer perspective.Design:Cost-effectiveness analysis using decision tree modelling.Methods:A structured literature search was conducted to estimate the clinical effectiveness and the rate of complications in the five methods. Data on costs and health-related quality of life associated with varicose vein disease were also collected. With the aid of an expert panel, a structured decision tree was developed. A 1-year perspective was modelled, and a variety of common complications were included. Monte Carlo simulation was used for probabilistic sensitivity analyses.Results:The laser ablation strategy was the most cost-effective option from a societal perspective, with an incremental cost-effectiveness ratio of €8448 compared to a no-treatment alternative, and had a 42% probability of being cost-effective using the Norwegian willingness-to-pay threshold of €59,880. From a healthcare payer perspective, however, the steam vein sclerosis strategy was the most cost-effective with an incremental cost-effectiveness ratio of €4072 compared to a no-treatment alternative, and this strategy had a 50% probability of being cost-effective.Conclusion:Results from this study did depend upon the perspective chosen for analyses. Although recent endovenous surgical procedures (including laser ablation and steam vein sclerosis) provide clinically effective treatment for advanced, symptomatic varicose vein disease, availability of high-level data is currently limiting the cost-effectiveness analyses.

Cost-effectiveness analysis of current varicose veins treatments

“…Another recent review and economic modelling paper finds EVLA to be most cost-effective in Norway from a societal (patient and NHS cost) perspective, and steam vein sclerosis to be most cost-effective from a NHS-only perspective over a one-year time horizon [72].…”

Efficiency and Midterm Results of Glue Ablation with Cyanoacrylate and Endovenous Thermal Ablation with Radiofrequency of Great Saphenous Vein Under Warfarin Therapy

“…[10] Bozkurt et al [11] reported that the one-year success rate of endovenous thermal ablation with laser and glue ablation was 92.2% and 95.8%, respectively (P=0.138) in patients without warfarin therapy. In addition, Park [5] reported that the VenaSeal system was found to be safe and efficient for the treatment of reflux of small saphenous vein with 100% patient's satisfaction. The main advantages of glue ablation over endovenous thermal ablation are including less pain, hematoma, and ecchymosis.…”

“…The main advantages of glue ablation over endovenous thermal ablation are including less pain, hematoma, and ecchymosis. [5] Due to potential postprocedural hemorrhage, the majority of authors are recommended to discontinue warfarin therapy prior to procedure. [9] However, some authors advocated that continuation of anticoagulant therapy does not affect the success rate of endovenous thermal ablation and foam sclerotherapy.…”

“…[3] On the other hand, new generation minimally invasive treatment modalities including glue ablation with cyanoacrylate closure, foam therapy and mechanochemical ablation (MOCA) are less invasive, reduce pain and provide fast recovery. [4][5][6] The volume of patients under anticoagulation therapy due to several diseases has recently increased among patients who underwent great saphenous vein ablation due to chronic venous insufficiency however, it is still a therapeutic dilemma. The studies investigating and comparing the success of ablation and postprocedural outcomes in mid-term and long-term follow-up of glue ablation with cyanoacrylate closure (nonthermal, nontumescent) and endovenous thermal ablation (with either laser or radiofrequency) for the treatment of chronic venous insufficiency are scarce.…”

Ny, bedre og billigere åreknutebehandling

“…Det finnes eksempler på at forskjellige perspektiv kan føre til helt ulike konklusjoner om kostnadseffektiviteten. I en publikasjon fra 2018 gjennomførte vi en bred analyse av tilgjengelige behandlingsmodaliteter for åreknutekirurgi i det norske helsevesenet (4). Analysen viste at nye endovaskulaere teknikker (som damp eller laser) kom best ut, i saerdeleshet sammenholdt med tradisjonell kirurgi.…”