For the investigation, a decision tree economic model was designed to compare seven strategies for the management of unilateral and bilateral greater saphenous vein reflux. One year recanalisation rates, the need for additional therapy and incidence of deep vein thrombosis were considered for each treatment strategy and probability estimates for each outcome were obtained from published prospective studies. For the purpose of the analysis, it was assumed that bilateral great saphenous vein surgery was only performed under general anaesthesia, and residual varicosities were treated using foam sclerotherapy as an outpatient. Modelling was performed with professional guidance using specialist software.
The primary outcome measure was estimated mean cost over one year and component costs were obtained from UK NHS published costs and device manufacturers.
The results showed that, for both unilateral and bilateral great saphenous vein reflux, foam sclerotherapy was found to be the cheapest treatment (€581 and €1078 respectively), despite the lower reported occlusion rates and higher need for repeat interventions. Both endovenous laser (€1111) and radiofrequency ablation (€1318) performed using local anaesthesia were cheaper than traditional surgery performed as a day case (€1431) for unilateral disease, whereas endovenous ablation under general anaesthesia was more expensive (€1890 and €2111 for laser therapy and radiofrequency ablation respectively).
For bilateral great saphenous vein disease, the costs of laser therapy (€2057) and radiofrequency ablation (€2309) under general anaesthesia were comparable to local anaesthesia procedures (€2057 and €2413 respectively), but more expensive than surgery (€1669).
“Foam sclerotherapy is likely to represent the least expensive modality for the treatment of primary unilateral and bilateral great saphenous vein reflux,” the study concluded. “Treatment of unilateral great saphenous vein reflux using endovenous laser treatment or radiofrequency ablation under local anaesthesia may be cheaper than open surgery. As both legs may be treated at the same time, the cost effectiveness of general anaesthesia surgery is probably greatest in patients requiring bilateral surgery.”
“This study demonstrated that the cost of varicose vein surgery varies hugely, depending on the choice of treatment modality and strategy. Consideration of these issues is essential in conjunction with clinical and quality of life outcomes to provide efficacious and cost-effective treatment to patients with superficial venous disease,” said Gohel.
