Cost-effectiveness of ultrasound-guided foam sclerotherapy, endovenous laser ablation or surgery as treatment for primary varicose veins from the randomized CLASS trial

Background The treatment of patients with varicose veins constitutes a considerable workload and financial burden to the National Health Service. This study aimed to assess the cost‐effectiveness of ultrasound‐guided foam sclerotherapy (UGFS) and endovenous laser ablation (EVLA) compared with conven...

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Bibliographic Details
Published in:British journal of surgery 2014-11, Vol.101 (12), p.1532-1540
Main Authors: Tassie, E., Scotland, G., Brittenden, J., Cotton, S. C., Elders, A., Campbell, M. K., Campbell, B., Gough, M., Burr, J. M., Ramsay, C. R.
Format: Article
Language:English
Subjects:
Adult
Aged
Combined Modality Therapy - economics
Combined Modality Therapy - methods
Cost-Benefit Analysis
Endovascular Procedures - economics
Endovascular Procedures - methods
Humans
Laser Therapy - economics
Laser Therapy - methods
Middle Aged
Quality-Adjusted Life Years
Sclerotherapy - economics
Sclerotherapy - methods
Treatment Outcome
Varicose Veins - economics
Varicose Veins - therapy
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Summary:Background The treatment of patients with varicose veins constitutes a considerable workload and financial burden to the National Health Service. This study aimed to assess the cost‐effectiveness of ultrasound‐guided foam sclerotherapy (UGFS) and endovenous laser ablation (EVLA) compared with conventional surgery as treatment for primary varicose veins. Methods Participant cost and utility data were collected alongside the UK CLASS multicentre randomized clinical trial, which compared EVLA, surgery and UGFS. Regression methods were used to estimate the effects of the alternative treatments on costs to the health service and quality‐adjusted life‐years (QALYs) at 6 months. A Markov model, incorporating available evidence on clinical recurrence rates, was developed to extrapolate the trial data over a 5‐year time horizon. Results Compared with surgery at 6 months, UGFS and EVLA reduced mean costs to the health service by £655 and £160 respectively. When additional overhead costs associated with theatre use were included, these cost savings increased to £902 and £392 respectively. UGFS produced 0·005 fewer QALYs, whereas EVLA produced 0·011 additional QALYs. Extrapolating to 5 years, EVLA was associated with increased costs and QALYs compared with UGFS (costing £3640 per QALY gained), and generated a cost saving (£206–439) and QALY gain (0·078) compared with surgery. Applying a ceiling willingness‐to‐pay ratio of £20 000 per QALY gained, EVLA had the highest probability (78·7 per cent) of being cost‐effective. Conclusion The results suggest, for patients considered eligible for all three treatment options, that EVLA has the highest probability of being cost‐effective at accepted thresholds of willingness to pay per QALY. Endovenous laser ablation most cost‐effective
ISSN:0007-1323
1365-2168
DOI:10.1002/bjs.9595