5M-5
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
Method: In collaboration with an expert panel we developed a one-year decision tree model that captured successful treatment as well as various complications including deep vein thrombosis and pulmonary embolism. We undertook a review of the literature to determine the clinical effectiveness and the risk of complications for the five methods. Data on resource use were collected from surgical departments while utility weights for varicose vein disease and treatment complication were captured from scientific literature. Uncertainty in utility and probability parameters was expressed with beta distributions while gamma distributions were used for costs.
Result: In the societal perspective, the laser ablation strategy compared to no therapy entailed one year costs of $2,193 and 0.180 QALY ($11,888 per QALY), and had a 42% probability of being cost-effective using the national willingness-to-pay threshold of $85,000. The incremental cost per QALY of replacing laser ablation with steam vein sclerosis was $55,244 while the three other alternatives were dominated. In a health care perspective, however, the steam vein sclerosis strategy had the lowest incremental cost-effectiveness ratio ($5,731 per QALY) while all other treatments were dominated, but still steam vein sclerosis had only a 50% probability of being cost-effective.
Conclusion: In a societal perspective, laser ablation is a cost-effective intervention with the current willingness to pay for a QALY, while other strategies were either cost-ineffective or were dominated. In a health care perspective, steam vein sclerosis was the treatment of choice.