Cost-Effectiveness of Current and Emerging Treatments of Varicose Veins

被引:37
作者
Epstein, David [1 ]
Onida, Sarah [2 ,3 ]
Bootun, Roshan [2 ,3 ]
Ortega-Ortega, Marta [4 ]
Davies, Alun H. [2 ,3 ]
机构
[1] Univ Granada, Dept Appl Econ, Sch Econ & Business Studies, Granada, Spain
[2] Imperial Coll London, Acad Sect Vasc Surg, Div Surg, Dept Surg & Canc, London, England
[3] Charing Cross Hosp, London, England
[4] Univ Complutense Madrid, Dept Appl Econ Publ Econ & Polit Econ, Sch Business & Econ, Campus Somosaguas, Madrid 28223, Spain
关键词
cost-effectiveness; economic evaluation; endothermal; varicose veins; vascular; ENDOVENOUS LASER-ABLATION; RANDOMIZED CLINICAL-TRIAL; GREAT SAPHENOUS-VEIN; GUIDED FOAM SCLEROTHERAPY; RADIOFREQUENCY OBLITERATION CLOSURE; 5-YEAR FOLLOW-UP; HIGH LIGATION; CONVENTIONAL SURGERY; MECHANOCHEMICAL ABLATION; COMPARING SURGERY;
D O I
10.1016/j.jval.2018.01.012
中图分类号
F [经济];
学科分类号
02 ;
摘要
Objectives: To analyze the cost-effectiveness of current technologies (conservative care [CONS], high-ligation surgery [HL/S], ultrasound-guided foam sclerotherapy [UGFS], endovenous laser ablation [EVLA], and radiofrequency ablation [RFA]) and emerging technologies (mechanochemical ablation [MOCA] and cyanoacrylate glue occlusion [CAE]) for treatment of varicose veins over 5 years. Methods: A Markov decision model was constructed. Effectiveness was measured by re-intervention on the truncal vein, re-treatment of residual varicosities, and quality-adjusted life-years (QALYs) over 5 years. Model inputs were estimated from systematic review, the UK National Health Service unit costs, and manufacturers' list prices. Univariate and probabilistic sensitivity analyses were undertaken. Results: CONS has the lowest overall cost and quality of life per person over 5 years; HL/S, EVLA, RFA, and MOCA have on average similar costs and effectiveness; and CAE has the highest overall cost but is no more effective than other therapies. The incremental cost per QALY of RFA versus CONS was 5,148 pound/QALY. Time to return to work or normal activities was significantly longer after HL/S than after other procedures. Conclusions: At a threshold of 20,000 pound/QALY, RFA was the treatment with highest median rank for net benefit, with MOCA second, EVLA third, HL/S fourth, CAE fifth, and CONS and UGFS sixth. Further evidence on effectiveness and health-related quality of life for MOCA and CAE is needed. At current prices, CAE is not a cost-effective option because it is costlier but has not been shown to be more effective than other options.
引用
收藏
页码:911 / 920
页数:10
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