Abstract
BackgroundAlthough widely applied, the cost-effectiveness of endovenous laser ablation (EVLT) for varicose veins has not been established.MethodsCost-effectiveness analysis was performed on the evaluation of EVLT for the treatment of uncomplicated varicose veins by using published data from randomizd clinical trials regarding the costs and the quality of life. Incremental cost per quality-adjusted life year (QALY) gained at 6 months following treatment was calculated. Sensitivity analysis was carried out to investigate the uncertainty associated with the results of our analysis.ResultsOver the time horizon of 1–6 months, it was found that the incremental cost of EVLT compared with conventional surgery was €466.66 and the incremental effect was −0.007 QALY at 1 month, −0.0075 QALY at 3 months and 0.0 QALY at 6 months. This shows that the strategy “EVLT” was dominated by the strategy “HL/S” at any time point for the base cases analyses. The results of various alternative economic evaluations indicated that EVLT may be a potentially cost effective (i.e. incremental cost effectiveness ratio of between €12158.67 and €514721.67 per QALY, respectively) treatment option compared to conventional surgical treatment for varicose veins with a certainty between 54.9 and 98.8 %.ConclusionFor patients with uncomplicated varicose veins and evidence of saphenofemoral reflux, surgical treatment for varicose veins offers a robust health benefit for relatively less costs compared to EVLT.
Highlights
Widely applied, the cost-effectiveness of endovenous laser ablation (EVLT) for varicose veins has not been established
The direct procedure-related costs were higher in the EVLT group, but the difference between the groups was somewhat reduced by the lower loss of productivity among the EVLT patients
By using these calculated cost and utility estimates, we suggest that EVLT is a cost-effective alternative to high ligation and stripping (HL/S) with a certainty of only 12.49 % in our base case 1, and of 0.46 % in our base case 2, at a threshold of € 50,000/ quality-adjusted life year (QALY)
Summary
The cost-effectiveness of endovenous laser ablation (EVLT) for varicose veins has not been established. Varicose veins are a common problem of Western adults. The Framingham Study (USA) demonstrated a biannual incidence rate of varicose veins of 2.6 % in women and 2.0 % in men. The prevalence of varicose veins in Western populations has been estimated to be about 25–30 % among women and 10–20 % in men [1]. They represent a huge burden on the health systems. Patients with varicose veins account for large numbers of outpatient attendances in primary and secondary care [2]. Varicose veins may be asymptomatic, especially in the early periods of the disease, frequent
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