Cost-effectiveness of treatments for superficial venous reflux in patients with chronic venous ulceration.

D Epstein,A H Davies,F Heatley,M Gohel

doi:10.1002/bjs5.56

D Epstein, A H Davies + Show 2 more

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https://doi.org/10.1002/bjs5.56

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Abstract

BackgroundVenous leg ulcers impair quality of life significantly, with substantial costs to health services. The aim of this study was to estimate the cost‐effectiveness of interventional procedures alongside compression therapy versus compression therapy alone for the treatment of chronic venous leg ulceration.MethodsA Markov decision analytical model was developed. The main outcome measures were quality‐adjusted life‐years (QALYs) and lifetime costs per patient, from the perspective of the UK National Health Service at 2015 prices. Resource use included the initial procedures, compression therapy, primary care and outpatient consultations. The interventional procedures included superficial venous surgery, endothermal ablation and ultrasound‐guided foam sclerotherapy (UGFS). The study population was patients with a chronic venous ulcer who were eligible for either compression therapy or an interventional procedure. Data were obtained from systematic review and meta‐analysis of RCTs.ResultsSurgery gained 0·112 (95 per cent c.i. −0·011 to 0·213) QALYs compared with compression therapy alone, with a difference in lifetime costs of €−1330 (−3570 to 1262). Given the expected savings in community care, the procedure would pay for itself within 4 years. There was insufficient evidence regarding endothermal ablation and UGFS to draw conclusions.DiscussionThis modelling study found surgery to be more effective and less costly than compression therapy alone. Further RCT evidence is required for both endothermal ablation and UGFS.

Highlights

Chronic venous hypertension is the most common cause of leg ulceration
It has been estimated that the UK National Health Service (NHS) manages 278 000 venous leg ulcers each year, at an annual cost of €1024 million (£941 million; exchange rate £1 = €1⋅0882), mostly in primary care and community nursing services[3]
Surgery gained 0⋅112 (95 per cent c.i. −0⋅011 to 0⋅213) quality-adjusted life-years (QALYs) compared with compression therapy alone, with a difference in lifetime costs of €−1330 (−3570 to 1262)

Summary

Introduction

Chronic venous hypertension is the most common cause of leg ulceration. The natural history is that of a continuous cycle of healing and breakdown of skin tissues over decades, causing considerable disability and impaired quality of life[1]. It has been estimated that the UK National Health Service (NHS) manages 278 000 venous leg ulcers each year, at an annual cost of €1024 million (£941 million; exchange rate £1 = €1⋅0882), mostly in primary care and community nursing services[3]. Venous leg ulcers impair quality of life significantly, with substantial costs to health services. The aim of this study was to estimate the cost-effectiveness of interventional procedures alongside compression therapy versus compression therapy alone for the treatment of chronic venous leg ulceration. The main outcome measures were quality-adjusted life-years (QALYs) and lifetime costs per patient, from the perspective of the UK National Health Service at 2015 prices. The interventional procedures included superficial venous surgery, endothermal ablation and ultrasound-guided foam sclerotherapy (UGFS). The study population was patients with a chronic venous ulcer who were eligible for either compression therapy or an interventional procedure. Further RCT evidence is required for both endothermal ablation and UGFS

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