David Epstein1, Roshan Bootun2, Modou Diop1, Marta Ortega-Ortega3, Tristan R A Lane4, Alun H Davies5. 1. Department of Applied Economics, School of Economics and Business Studies, University of Granada, Granada, Spain. 2. Academic Section of Vascular Surgery, Department of Surgery & Cancer, Imperial College London, London, UK; Department of Vascular Surgery, Norfolk and Norwich University Hospital, Norwich, UK. 3. Department of Applied and Public Economics, and Political Economy, Complutense University of Madrid, Madrid, Spain. 4. Academic Section of Vascular Surgery, Department of Surgery & Cancer, Imperial College London, London, UK; Department of Vascular Surgery, Addenbrooke's Hospital, Cambridge University Hospital, Cambridge, UK. 5. Academic Section of Vascular Surgery, Department of Surgery & Cancer, Imperial College London, London, UK; Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, UK. Electronic address: a.h.davies@imperial.ac.uk.
Abstract
OBJECTIVE: To analyze the effectiveness and cost effectiveness of technologies for treatment of varicose veins over 5 years-conservative care, surgery (high ligation and stripping), ultrasound-guided foam sclerotherapy (UGFS), endovenous laser ablation (EVLA), and radiofrequency ablation (RFA), mechanochemical ablation (MOCA), and cyanoacrylate glue occlusion (CAE). METHODS: A systematic review was updated and used to construct a Markov decision model. Outcomes were reintervention on the truncal vein, retreatment of residual varicosities and quality-adjusted life years (QALY) and costs over 5 years. RESULTS: UGFS has a significantly greater reintervention rate than other procedures; there is no significant difference between the other procedures. The cost per QALY of EVLA vs UGFS in our base-case model is £16,966 ($23,700) per QALY, which is considered cost effective in the UK. RFA, MOCA, and CAE have greater procedure costs than EVLA with no evidence of greater benefit for patients. CONCLUSIONS: EVLA is the most cost-effective therapeutic option, with RFA a close second, in adult patients requiring treatment in the upper leg for incompetence of the GSV. MOCA, UGFS, CAE, conservative care, and high ligation and stripping are not cost effective at current prices in the UK National Health Service. MOCA and CAE seem to be promising, but further evidence on the effectiveness, reinterventions, and health-related quality of life is needed, as well as how cost effectiveness may vary across settings and reimbursement systems. Crown
OBJECTIVE: To analyze the effectiveness and cost effectiveness of technologies for treatment of varicose veins over 5 years-conservative care, surgery (high ligation and stripping), ultrasound-guided foam sclerotherapy (UGFS), endovenous laser ablation (EVLA), and radiofrequency ablation (RFA), mechanochemical ablation (MOCA), and cyanoacrylate glue occlusion (CAE). METHODS: A systematic review was updated and used to construct a Markov decision model. Outcomes were reintervention on the truncal vein, retreatment of residual varicosities and quality-adjusted life years (QALY) and costs over 5 years. RESULTS: UGFS has a significantly greater reintervention rate than other procedures; there is no significant difference between the other procedures. The cost per QALY of EVLA vs UGFS in our base-case model is £16,966 ($23,700) per QALY, which is considered cost effective in the UK. RFA, MOCA, and CAE have greater procedure costs than EVLA with no evidence of greater benefit for patients. CONCLUSIONS: EVLA is the most cost-effective therapeutic option, with RFA a close second, in adult patients requiring treatment in the upper leg for incompetence of the GSV. MOCA, UGFS, CAE, conservative care, and high ligation and stripping are not cost effective at current prices in the UK National Health Service. MOCA and CAE seem to be promising, but further evidence on the effectiveness, reinterventions, and health-related quality of life is needed, as well as how cost effectiveness may vary across settings and reimbursement systems. Crown
Authors: Muhammad Rahil Aslam; Hafiz Muhammad Asif; Khalil Ahmad; Sana Jabbar; Abdul Hayee; Muhammad Shahid Sagheer; Jalil Ur Rehman; Sana Khalid; Abdul Sattar Hashmi; Sehrish Rana Rajpoot; Aamir Sharif Journal: SAGE Open Med Date: 2022-08-25