Editor's Choice - Short Term Cost Effectiveness of Radiofrequency Ablation and High Ligation and Stripping for Great Saphenous Vein Incompetence.

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  • Author(s): Nelzén O;Nelzén O; Skoog J; Skoog J; Bernfort L; Bernfort L; Zachrisson H; Zachrisson H
  • Source:
    European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery [Eur J Vasc Endovasc Surg] 2024 May; Vol. 67 (5), pp. 811-817. Date of Electronic Publication: 2024 Feb 02.
  • Publication Type:
    Journal Article; Randomized Controlled Trial; Comparative Study
  • Language:
    English
  • Additional Information
    • Source:
      Publisher: Elsevier Country of Publication: England NLM ID: 9512728 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1532-2165 (Electronic) Linking ISSN: 10785884 NLM ISO Abbreviation: Eur J Vasc Endovasc Surg Subsets: MEDLINE
    • Publication Information:
      Publication: 2002-: London : Elsevier
      Original Publication: London, UK : W.B. Saunders Co. Ltd., c1995-
    • Subject Terms:
      Cost-Benefit Analysis* ; Saphenous Vein*/surgery ; Saphenous Vein*/diagnostic imaging ; Venous Insufficiency*/surgery ; Venous Insufficiency*/economics ; Venous Insufficiency*/diagnostic imaging ; Quality of Life* ; Radiofrequency Ablation*/economics ; Radiofrequency Ablation*/adverse effects; Humans ; Ligation/economics ; Female ; Male ; Middle Aged ; Treatment Outcome ; Quality-Adjusted Life Years ; Time Factors ; Vascular Surgical Procedures/economics ; Vascular Surgical Procedures/adverse effects ; Vascular Surgical Procedures/methods ; Aged ; Catheter Ablation/economics ; Catheter Ablation/adverse effects ; Catheter Ablation/methods ; Adult ; Health Care Costs ; Varicose Veins/surgery ; Varicose Veins/economics ; Varicose Veins/diagnostic imaging ; Cost-Effectiveness Analysis
    • Abstract:
      Objective: Superficial venous incompetence (SVI) is a common disease that causes significant quality of life (QoL) impairment. There is a need for more health economic evaluations of SVI treatment. The aim of this study was to perform a cost effectiveness analysis in patients with great saphenous vein (GSV) incompetence comparing radiofrequency ablation (RFA), high ligation and stripping (HL/S), and no treatment or conservative treatment with one year follow up.
      Methods: Randomised controlled trial economic analysis from an ongoing trial; 143 patients (156 limbs) with GSV incompetence (CEAP clinical class 2 - 6) were included. Treatment was performed with RFA or HL/S. Follow up was performed up to one year using duplex ultrasound, revised venous clinical severity score (r-VCSS), Aberdeen Varicose Vein Questionnaire (AVVQ), and EuroQol-5D-3L (EQ-5D-3L).
      Results: Seventy-eight limbs were treated with RFA and HL/S respectively. No treatment or conservative treatment was assumed to have zero in treatment cost and no treatment benefit. In the RFA group, one limb had reflux in the GSV after one month and three limbs after one year. In HL/S, two limbs had remaining reflux in the treated area at one month and one year. Both disease severity (r-VCSS, p = .004) and QoL (AVVQ, p = .021 and EQ-5D-3L, p = .028) were significantly improved over time. The QALY gain was 0.21 for RFA and 0.17 for HL/S. The cost per patient was calculated as €1 292 for RFA and €2 303 for HL/S. The cost per QALY (compared with no treatment or conservative treatment) was €6 155 for RFA and €13 549 for HL/S. With added cost for days absent from work the cost per QALY was €7 358 for RFA and €24 197 for HL/S. The cost per QALY for both methods was well below the threshold suggested by Swedish National Board of Health.
      Conclusion: RFA is more cost effective than HL/S and no treatment or conservative treatment at one year follow up.
      (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)
    • Contributed Indexing:
      Keywords: Cost effectiveness; Great saphenous vein incompetence; High ligation and stripping; Radiofrequency ablation; Superficial venous incompetence
    • Publication Date:
      Date Created: 20240204 Date Completed: 20240516 Latest Revision: 20240516
    • Publication Date:
      20240517
    • Accession Number:
      10.1016/j.ejvs.2024.01.085
    • Accession Number:
      38311050