A Cost-effectiveness Analysis of Surgery, Endothermal Ablation, Ultrasound-guided Foam Sclerotherapy and Compression Stockings for Symptomatic Varicose Veins

被引:39
作者
Marsden, G. [1 ]
Perry, M. [1 ]
Bradbury, A. [2 ]
Hickey, N. [3 ]
Kelley, K. [1 ]
Trender, H. [4 ]
Wonderling, D. [1 ]
Davies, A. H. [5 ,6 ]
机构
[1] Royal Coll Physicians, Natl Clin Guideline Ctr, London NW1 4LE, England
[2] Univ Birmingham, Univ Dept Vasc Surg, Solihull, W Midlands, England
[3] Worcestershire Royal Hosp, Worcester, MA USA
[4] Sheffield Teaching Hosp Fdn Trust, Sheffield Vasc Inst, Sheffield, S Yorkshire, England
[5] Univ London Imperial Coll Sci Technol & Med, Dept Surg & Canc, London, England
[6] Imperial Coll NHS Trust, Charing Cross Hosp, London, England
关键词
Varicose veins; Quality-adjusted life years; Cost benefit analysis; Costs and cost analysis; Surgery; ENDOVENOUS LASER-ABLATION; RANDOMIZED CLINICAL-TRIAL; QUALITY-OF-LIFE; SAPHENOUS-VEIN; GREAT; LIGATION;
D O I
10.1016/j.ejvs.2015.07.034
中图分类号
R61 [外科手术学];
学科分类号
摘要
Objective: The aim was to investigate the cost-effectiveness of interventional treatment for varicose veins (VV) in the UK NHS, and to inform the national clinical guideline on VV, published by the National Institute of Health and Care Excellence. Design: An economic analysis was constructed to compare the cost-effectiveness of surgery, endothermal ablation (ETA), ultrasound-guided foam sclerotherapy (UGFS), and compression stockings (CS). The analysis was based on a Markov decision model, which was developed in consultation with members of the NICE guideline development group (GDG). Methods: The model had a 5-year time horizon, and took the perspective of the UK National Health Service. Clinical inputs were based on a network meta-analysis (NMA), informed by a systematic review of the clinical literature. Outcomes were expressed as costs and quality-adjusted life years (QALYs). Results: All interventional treatments were found to be cost-effective compared with CS at a cost-effectiveness threshold of 20,000 per QALY gained. ETA was found to be the most cost-effective strategy overall, with an incremental cost-effectiveness ratio of 3,161 per QALY gained compared with UGFS. Surgery and CS were dominated by ETA. Conclusions: Interventional treatment for VV is cost-effective in the UK NHS. Specifically, based on current data, ETA is the most cost-effective treatment in people for whom it is suitable. The results of this research were used to inform recommendations within the NICE guideline on VV. (C) 2015 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.
引用
收藏
页码:794 / 801
页数:8
相关论文
共 32 条
[1]  
[Anonymous], 2013, VAR VEINS LEGS DIAGN
[2]   Deriving an Algorithm to Convert the Eight Mean SF-36 Dimension Scores into a Mean EQ-5D Preference-Based Score from Published Studies (Where Patient Level Data Are Not Available) [J].
Ara, Roberta ;
Brazier, John .
VALUE IN HEALTH, 2008, 11 (07) :1131-1143
[3]   A comparison of health-related quality of life of patients with primary and recurrent varicose veins [J].
Beresford, T ;
Smith, JJ ;
Brown, L ;
Greenhalgh, RM ;
Davies, AH .
PHLEBOLOGY, 2003, 18 (01) :35-37
[4]   Comparing endovenous laser ablation, foam sclerotherapy, and conventional surgery for great saphenous varicose veins [J].
Biemans, Anke A. M. ;
Kockaert, Michael ;
Akkersdijk, George P. ;
van den Bos, Renate R. ;
de Maeseneer, Marianne G. R. ;
Cuypers, Philip ;
Stijnen, Theo ;
Neumann, Martino H. A. ;
Nijsten, Tamar .
JOURNAL OF VASCULAR SURGERY, 2013, 58 (03) :727-+
[5]   Ultrasound-guided foam sclerotherapy combined with sapheno-femoral ligation compared to surgical treatment of varicose veins: Early results of a randomised controlled trial [J].
Bountouroglou, DG ;
Azzam, M ;
Kakkos, SK ;
Pathmarajah, M ;
Young, P ;
Geroulakos, G .
EUROPEAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY, 2006, 31 (01) :93-100
[6]   Simultaneous comparison of multiple treatments: combining direct and indirect evidence [J].
Caldwell, DM ;
Ades, AE ;
Higgins, JPT .
BMJ-BRITISH MEDICAL JOURNAL, 2005, 331 (7521) :897-900
[7]   Randomized clinical trial of concomitant or sequential phlebectomy after endovenous laser therapy for varicose veins [J].
Carradice, D. ;
Mekako, A. I. ;
Hatfield, J. ;
Chetter, I. C. .
BRITISH JOURNAL OF SURGERY, 2009, 96 (04) :369-375
[8]  
Carroll C, 2013, HLTH TECHNOL ASSESS, V17
[9]   Changes in health-related quality of life after ultrasound-guided foam sclerotherapy for great and small saphenous varicose veins [J].
Darvall, Katy A. L. ;
Sam, Rachel C. ;
Bate, Gareth R. ;
Silverman, Stanley H. ;
Adam, Donald J. ;
Bradbury, Andrew W. .
JOURNAL OF VASCULAR SURGERY, 2010, 51 (04) :913-920
[10]   Great Saphenous Vein Radiofrequency Ablation Versus Standard Stripping in the Management of Primary Varicose Veins-A Randomized Clinical Trial [J].
ElKaffas, Khaled Helmy ;
ElKashef, Omar ;
ElBaz, Walied .
ANGIOLOGY, 2011, 62 (01) :49-54