Imperial College London
Alternate

Professor Alun H Davies, MA,DM,DSc,FRCS,FHEA,FEBVS,FACPh

Faculty of Medicine, Department of Surgery & Cancer

Professor of Vascular Surgery
 
 
 
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Contact

 

+44 (0)20 3311 7309a.h.davies

 
 
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Location

 

4E04 EastEast WingCharing Cross Campus

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Summary

 

Publications

Citation

BibTex format

@article{Epstein:2022:10.1016/j.jvsv.2021.05.014,
author = {Epstein, D and Bootun, R and Diop, M and Ortega-Ortega, M and Lane, TRA and Davies, AH},
doi = {10.1016/j.jvsv.2021.05.014},
journal = {Journal of vascular surgery. Venous and lymphatic disorders},
pages = {504--513.e7},
title = {Cost-effectiveness analysis of current varicose veins treatments},
url = {http://dx.doi.org/10.1016/j.jvsv.2021.05.014},
volume = {10},
year = {2022}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - OBJECTIVE: To analyze the effectiveness and cost-effectiveness of technologies for treatment of varicose veins over 5 years - conservative care (CONS), surgery (HL/S), ultrasound guided foam sclerotherapy (UGFS), endovenous laser ablation (EVLA), and radiofrequency ablation (RFA), mechanochemical ablation (MOCA) and cyanoacrylate glue occlusion (CAE). METHODS: A systematic review was updated and used to construct a Markov decision model. Outcomes were re-intervention on the truncal vein, re-treatment of residual varicosities and quality-adjusted life years (QALY) and costs over five years. RESULTS: UGFS has a significantly greater re-intervention rate than other procedures, while there is no significant difference between the other procedures. The cost per QALY of EVLA versus UGFS in our base-case model is £16966 ($23700) per QALY, which is considered cost-effective in the UK. RFA, MOCA and CAE have greater procedure costs than EVLA with no evidence of greater benefit for patients. CONCLUSIONS: EVLA is the most cost-effective therapeutic option, with RFA a close second, in adult patients requiring treatment in the upper leg for incompetence of the GSV. MOCA, UGFS, CAE, CONS and HL/S are not cost-effective at current prices in the UK National Health Service. MOCA and CAE appear promising but further evidence on effectiveness, re-interventions and health-related quality of life is needed, as well as how cost-effectiveness may vary across settings and reimbursement systems.
AU  - Epstein,D
AU  - Bootun,R
AU  - Diop,M
AU  - Ortega-Ortega,M
AU  - Lane,TRA
AU  - Davies,AH
DO  - 10.1016/j.jvsv.2021.05.014
EP  - 513
PY  - 2022///
SN  - 2213-3348
SP  - 504
TI  - Cost-effectiveness analysis of current varicose veins treatments
T2  - Journal of vascular surgery. Venous and lymphatic disorders
UR  - http://dx.doi.org/10.1016/j.jvsv.2021.05.014
UR  - https://www.ncbi.nlm.nih.gov/pubmed/34450353
UR  - http://hdl.handle.net/10044/1/93549
VL  - 10
ER  -
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