Document Detail


Cost-effectiveness of traditional and endovenous treatments for varicose veins.
MedLine Citation:
PMID:  20922783     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The aim of this study was to evaluate the cost-effectiveness of traditional and endovenous treatments for patients with primary great saphenous varicose veins.
METHODS: A Markov model was constructed to compare costs and quality-adjusted life years (QALYs) for great saphenous vein (GSV) reflux. Eight popular treatment strategies were compared up to 5 years. Estimates for the effectiveness of treatments were obtained from published randomized studies and cost values were obtained from published National Health Service (NHS) healthcare resource group tariffs and device manufacturers. Parameter uncertainty was tested using sensitivity analysis and Monte Carlo simulation.
RESULTS: Ultrasound-guided foam sclerotherapy (UGFS) had the lowest initial cost, but a higher requirement for further interventions. Day-case surgery (with concomitant treatment of varicosities), endovenous laser ablation (EVLA) and radiofrequency ablation (RFA) performed in an outpatient or office setting (with staged treatment of varicosities) were likely to be cost-effective treatment strategies. The incremental cost-effectiveness ratio (ICER) for UGFS (versus conservative care), EVLA (versus UGFS) and RFA (versus EVLA) were £1366, £5799 and £17 350 per QALY respectively. The ICER for traditional surgery (performed on a day-case basis) was £19 012 compared with RFA. Other strategies were not cost-effective using the NHS threshold of £20 000 per QALY.
CONCLUSION: Day-case surgery or endovenous ablation using EVLA or RFA performed as an outpatient are likely to be cost-effective treatment strategies for patients with primary unilateral GSV reflux requiring treatment.
Authors:
M S Gohel; D M Epstein; A H Davies
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Publication Detail:
Type:  Comparative Study; Evaluation Studies; Journal Article; Research Support, Non-U.S. Gov't     Date:  2010-10-04
Journal Detail:
Title:  The British journal of surgery     Volume:  97     ISSN:  1365-2168     ISO Abbreviation:  Br J Surg     Publication Date:  2010 Dec 
Date Detail:
Created Date:  2010-11-08     Completed Date:  2010-12-27     Revised Date:  2011-01-26    
Medline Journal Info:
Nlm Unique ID:  0372553     Medline TA:  Br J Surg     Country:  England    
Other Details:
Languages:  eng     Pagination:  1815-23     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
Affiliation:
Imperial Vascular Unit, Charing Cross Hospital, London, UK.
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MeSH Terms
Descriptor/Qualifier:
Ambulatory Care / economics
Catheter Ablation / economics*
Cost-Benefit Analysis
Humans
Laser Therapy / economics*
Quality-Adjusted Life Years
Saphenous Vein
Sclerotherapy / economics*
Treatment Outcome
Varicose Veins / therapy*
Comments/Corrections
Comment In:
Br J Surg. 2010 Dec;97(12):1823-4   [PMID:  21058352 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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