Opportunity cost comparison of radiofrequency ablation and cyanoacrylate adhesive venous closures

Abstract

ObjectiveChronic venous insufficiency is a costly pathology affecting ≤40% of the U.S. population. Prior studies have highlighted the substantial burden of resource usage and work loss costs associated with this disease, with an estimate of upward of 2 million workdays lost annually in the United States alone. Endovenous closure of refluxing superficial veins has been proved to substantially improve patients’ health-related quality of life. Despite the transition from inpatient to outpatient ablation procedures, these minimally invasive techniques can still lead to the loss of working days and economic disability. The aim of the present study was to compare the time to return to work after treatment between two techniques of superficial vein closure: radiofrequency ablation (RFA) and cyanoacrylate adhesive closure (CAC). MethodsWe performed a multi-institutional retrospective review of actively employed patients with CEAP (Clinical, Etiology, Anatomy, Pathophysiology) class 2 to 5 disease who had undergone closure of their truncal veins from 2019 to 2020. The patients who had undergone RFA were compared with those who had undergone CAC. Patients with active venous leg ulcers were excluded. The primary end point was the time to return to work. The secondary end points included infection, thrombophlebitis, and postprocedure deep vein thrombosis. Multivariate linear regression analysis was used to examine the factors affecting the time to return to work in the most predictive model. The analysis was performed to exclude holidays and weekends. Statistical significance was defined as P < .05. ResultsA total of 97 patients were included in the study cohort, of whom 58 had undergone RFA and 39, CAC. Most of the patients in the cohort had had CEAP class 2 disease (60%). The patients in the RFA group were more frequently men (57% vs 33%; P = .023). Significantly more patients who had undergone CAC had had postprocedure thrombophlebitis (5% vs 33%; P < .001). The mean time to return to work was significantly shorter for the CAC group than for the RFA group (0.8 ± 1.4 days vs 1.3 ± 1.4 days; P = .003). On multivariate analysis, the treatment modality was the only modifiable factor in the time to return to work (P = .028). The development of postprocedure thrombophlebitis significantly increased the time to return to work for both groups (P = .038). No deep vein thrombosis or infection had developed after the procedure in either cohort. ConclusionsRFA and CAC have both been shown to be safe and effective treatments to eliminate truncal venous insufficiency. Despite the significantly higher rates of postprocedure thrombophlebitis, the CAC patients were able to return to work significantly more quickly, reducing the opportunity cost of missed workdays, compared with RFA.