M. AZZAM, C.R. LATTIMER, E. KALODIKI, G. GEROULAKOS
Imperial College, London, UK
Endothermal ablation (ETA) techniques and ultrasound-guided foam sclerotherapy (UGFS) for varicose
veins are gradually replacing conventional surgical stripping. The simplicity of the procedures and high
patient satisfaction has resulted in fast dissemination of the techniques despite the lack of evidence
regarding the balance between the costs involved and the benefi ts. The National Institute for Health and
Clinical Excellence (NICE) issued new guidelines in 2013 with recommendations on management and
A systematic review of the economic literature and new cost-effectiveness analyses in priority areas
was undertaken by a health economist. These included cost-utility, cost-effectiveness, cost-benefi t
and cost-consequence analyses. Economic evidence included studies comparing the costs and health
consequences of alternative courses of action. The NICE economic evidence profi le was used to
summarise cost-effectiveness using incremental costs, incremental outcomes with quality-adjusted life
years (QALY’s) and incremental cost-effectiveness ratios (ICER’s). When judging whether an intervention
offers good value for money a cut-off point of £20 000 per QALY gained was compared to the best
strategy. Recommendations were drafted taking into account the balance of benefi ts, harms and costs.
A strong recommendation was refl ected in the word “offer” in preference to the word “consider”.
All endothermal techniques and surgical stripping are cost effective with no signifi cant differences in
terms of clinical outcome. Treatments using ETA yielded comparable outcomes to surgery but at the
additional cost of the kits required and the use of duplex ultrasound. However, the cost of a general
anaesthetic was not required. Patients favoured ETA because of better cosmetic results, lower rates of
postoperative morbidity and quicker return to normal activities. Moreover, when comparing day-case
and outpatient procedures, it was found that the ICER was in favour of the outpatient procedure.
The outpatient location has a considerable impact on reducing costs for ETA.
Key words : varicose veins, cost-effectiveness