Costs and outcomes of five surgical treatments for great saphenous varicose veins; High Ligation and Stripping, Laser Ablation, Radiofrequency Ablation, Steam Vein Sclerosis and Cyanoacrylate Glue

Abstract

Background: Although varicose vein disease primarily causes cosmetic concern it can also develop into disabling venous ulcers. For advanced disease, surgical intervention is a mainstay for a majority of patients. Several new techniques have evolved during the last decade and a handful of these are offered through the Norwegian Statutory Health Care System. Few economic evaluations have been performed considering surgery for varicose vein disease, none including the range of new endovascular techniques. Objectives: The aim of the current thesis was to estimate costs and outcome of five common techniques of varicose vein surgery in a Norwegian Health Care Setting (high ligation and stripping, radiofrequency ablation, endovenous laser ablation, steam vein sclerosis and cyanoacrylate glue) using both a societal perspective and a health care perspective. Methods: A structured literature search was made to determine the clinical effectiveness and the rate of compilations in the five methods. Data on costs and health-related quality of life related to varicose vein disease were also collected. With the aid of an expert panel, a structured decision tree was developed using TreeAge software. A one-year perspective was modelled, and a variety of common complications were included. Monte Carlo simulation was used for probabilistic sensitivity analyses. Results: In the societal perspective the laser ablation strategy was the most cost-effective with an incremental cost-effectiveness-ratio (ICER) of NOK 70,539 compared to a no treatment alternative, and had a 42% probability of being cost-effective using a willingness-to-pay threshold of NOK 500,000. In a health care perspective, however, the steam vein sclerosis strategy was the most cost-effective with an ICER of NOK 34,005 compared to a no treatment alternative, and this strategy had a 50% probability of being cost-effective. Conclusion: Recent endovenous surgical treatment alternatives (including laser ablation and steam vein sclerosis) provide clinically effective treatment for advanced, symptomatic varicose vein disease and are cost-effective in a Norwegian Health Care Setting. The societal perspective envelop costs related to varicose vein surgery that are not accounted for in a health care perspective, and is therefore recommended when undertaking comprehensive cost-effectiveness analyses.