Cost-effectiveness of ultrasound-guided foam sclerotherapy, endovenous laser ablation or surgery as treatment for primary varicose veins from the randomized CLASS trial

Emma Tassie, Graham Scotland, Julie Brittenden, Seonaidh Cotton, Andrew Elders, Marion Campbell, Bruce Campbell, Michael Gough, Jennifer Burr, Craig Ramsay

Research output: Contribution to journalArticle

Abstract

Background: The treatment of patients with varicose veins constitutes a considerable workload and financial burden to the National Health Service. This study aimed to assess the cost-effectiveness of ultrasound-guided foam sclerotherapy (UGFS) and endovenous laser ablation (EVLA) compared with conventional surgery as treatment for primary varicose veins.
Methods: Participant cost and utility data were collected alongside the UK CLASS multicentre randomized clinical trial, which compared EVLA, surgery and UGFS. Regression methods were used to estimate the effects of the alternative treatments on costs to the health service and quality-adjusted life-years (QALYs) at 6 months. A Markov model, incorporating available evidence on clinical recurrence rates, was developed to extrapolate the trial data over a 5-year time horizon.
Results: Compared with surgery at 6 months, UGFS and EVLA reduced mean costs to the health service by £655 and £160 respectively. When additional overhead costs associated with theatre use were included, these cost savings increased to £902 and £392 respectively. UGFS produced 0·005 fewer QALYs, whereas EVLA produced 0·011 additional QALYs. Extrapolating to 5 years, EVLA was associated with increased costs and QALYs compared with UGFS (costing £3640 per QALY gained), and generated a cost saving (£206–439) and QALY gain (0·078) compared with surgery. Applying a ceiling willingness-to-pay ratio of £20 000 per QALY gained, EVLA had the highest probability (78·7 per cent) of being cost-effective.
Conclusion: The results suggest, for patients considered eligible for all three treatment options, that EVLA has the highest probability of being cost-effective at accepted thresholds of willingness to pay per QALY
Original languageEnglish
Pages (from-to)1532-1540
Number of pages9
JournalBritish Journal of Surgery
Volume121
Issue number12
DOIs
Publication statusPublished - Oct 2014

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Sclerotherapy
Quality-Adjusted Life Years
Varicose Veins
Laser Therapy
Cost-Benefit Analysis
Costs and Cost Analysis
Therapeutics
Health Services
Cost Savings
National Health Programs
Workload
Health Care Costs
Randomized Controlled Trials
Recurrence

Keywords

  • varicose veins
  • treatment
  • sclerotherapy
  • clinical trial
  • cost-effectiveness

Cite this

Tassie, Emma ; Scotland, Graham ; Brittenden, Julie ; Cotton, Seonaidh ; Elders, Andrew ; Campbell, Marion ; Campbell, Bruce ; Gough, Michael ; Burr, Jennifer ; Ramsay, Craig. / Cost-effectiveness of ultrasound-guided foam sclerotherapy, endovenous laser ablation or surgery as treatment for primary varicose veins from the randomized CLASS trial. In: British Journal of Surgery. 2014 ; Vol. 121, No. 12. pp. 1532-1540.
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Tassie, E, Scotland, G, Brittenden, J, Cotton, S, Elders, A, Campbell, M, Campbell, B, Gough, M, Burr, J & Ramsay, C 2014, 'Cost-effectiveness of ultrasound-guided foam sclerotherapy, endovenous laser ablation or surgery as treatment for primary varicose veins from the randomized CLASS trial', British Journal of Surgery, vol. 121, no. 12, pp. 1532-1540. https://doi.org/10.1002/bjs.9595

Cost-effectiveness of ultrasound-guided foam sclerotherapy, endovenous laser ablation or surgery as treatment for primary varicose veins from the randomized CLASS trial. / Tassie, Emma; Scotland, Graham; Brittenden, Julie; Cotton, Seonaidh; Elders, Andrew; Campbell, Marion; Campbell, Bruce; Gough, Michael; Burr, Jennifer; Ramsay, Craig.

In: British Journal of Surgery, Vol. 121, No. 12, 10.2014, p. 1532-1540.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Cost-effectiveness of ultrasound-guided foam sclerotherapy, endovenous laser ablation or surgery as treatment for primary varicose veins from the randomized CLASS trial

AU - Tassie, Emma

AU - Scotland, Graham

AU - Brittenden, Julie

AU - Cotton, Seonaidh

AU - Elders, Andrew

AU - Campbell, Marion

AU - Campbell, Bruce

AU - Gough, Michael

AU - Burr, Jennifer

AU - Ramsay, Craig

PY - 2014/10

Y1 - 2014/10

N2 - Background: The treatment of patients with varicose veins constitutes a considerable workload and financial burden to the National Health Service. This study aimed to assess the cost-effectiveness of ultrasound-guided foam sclerotherapy (UGFS) and endovenous laser ablation (EVLA) compared with conventional surgery as treatment for primary varicose veins.Methods: Participant cost and utility data were collected alongside the UK CLASS multicentre randomized clinical trial, which compared EVLA, surgery and UGFS. Regression methods were used to estimate the effects of the alternative treatments on costs to the health service and quality-adjusted life-years (QALYs) at 6 months. A Markov model, incorporating available evidence on clinical recurrence rates, was developed to extrapolate the trial data over a 5-year time horizon.Results: Compared with surgery at 6 months, UGFS and EVLA reduced mean costs to the health service by £655 and £160 respectively. When additional overhead costs associated with theatre use were included, these cost savings increased to £902 and £392 respectively. UGFS produced 0·005 fewer QALYs, whereas EVLA produced 0·011 additional QALYs. Extrapolating to 5 years, EVLA was associated with increased costs and QALYs compared with UGFS (costing £3640 per QALY gained), and generated a cost saving (£206–439) and QALY gain (0·078) compared with surgery. Applying a ceiling willingness-to-pay ratio of £20 000 per QALY gained, EVLA had the highest probability (78·7 per cent) of being cost-effective.Conclusion: The results suggest, for patients considered eligible for all three treatment options, that EVLA has the highest probability of being cost-effective at accepted thresholds of willingness to pay per QALY

AB - Background: The treatment of patients with varicose veins constitutes a considerable workload and financial burden to the National Health Service. This study aimed to assess the cost-effectiveness of ultrasound-guided foam sclerotherapy (UGFS) and endovenous laser ablation (EVLA) compared with conventional surgery as treatment for primary varicose veins.Methods: Participant cost and utility data were collected alongside the UK CLASS multicentre randomized clinical trial, which compared EVLA, surgery and UGFS. Regression methods were used to estimate the effects of the alternative treatments on costs to the health service and quality-adjusted life-years (QALYs) at 6 months. A Markov model, incorporating available evidence on clinical recurrence rates, was developed to extrapolate the trial data over a 5-year time horizon.Results: Compared with surgery at 6 months, UGFS and EVLA reduced mean costs to the health service by £655 and £160 respectively. When additional overhead costs associated with theatre use were included, these cost savings increased to £902 and £392 respectively. UGFS produced 0·005 fewer QALYs, whereas EVLA produced 0·011 additional QALYs. Extrapolating to 5 years, EVLA was associated with increased costs and QALYs compared with UGFS (costing £3640 per QALY gained), and generated a cost saving (£206–439) and QALY gain (0·078) compared with surgery. Applying a ceiling willingness-to-pay ratio of £20 000 per QALY gained, EVLA had the highest probability (78·7 per cent) of being cost-effective.Conclusion: The results suggest, for patients considered eligible for all three treatment options, that EVLA has the highest probability of being cost-effective at accepted thresholds of willingness to pay per QALY

KW - varicose veins

KW - treatment

KW - sclerotherapy

KW - clinical trial

KW - cost-effectiveness

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M3 - Article

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