Cost-effectiveness in varicose vein treatment

Abstract

Methods used in cost calculation have a profound effect on cost-effectiveness analyses, thereby influencing UK healthcare decision-making. The aim of this study was to quantify the impact of different cost assessments using data obtained alongside a recent randomised clinical trial (RCT) on endovenous treatments for varicose veins. National reimbursement data from payment by results (PbR) were compared to the service line report (SLR) and RCT micro-costing data. There were 18 laser and 205 foam treated patients from the 2010–2011 day-case activity SLR. There were 100 RCT patients which were separated for costing into session treatments (2 laser, 3 tumescent foam or 5 standard foam treatments per 3.5 hour session) as well as individually-timed treatments. Reimbursement was £1098, irrespective of treatment type. Using SLR derived data the cost of laser, tumescent foam and standard foam per patient was £1059, £603 and £551, respectively. This decreased to £812, £239 and £124 using session calculations and decreased further to a median (inter-quartile range) of £721 (677–774), £195 (176–209) and £100 (93–109) using individually timed treatments (P < 0.0005, Kruskal-Wallis). Cost differences between laser and foam increase significantly using micro-costing. Several costing approaches may be required for representative cost-effectiveness comparisons.