Randomised comparison of costs and cost-effectiveness of cryostripping and endovenous laser ablation for varicose veins: 2-year results.
BACKGROUND
Although endovenous laser ablation for varicose veins is replacing surgical stripping, proper economic evaluation with adequate follow-up in a randomised clinical trial is important for considered policy decisions regarding the implementation of new techniques.


METHODS
Data from a randomised controlled trial comparing cryostripping and endovenous laser ablation in 120 patients were combined to study Short Form (SF) 6D outcome, costs and cost-effectiveness 2 years after treatment. Incremental cost per quality-adjusted life year (QALY) gained 2 years after treatment was calculated using different strategies, and uncertainty was assessed with bootstrapping.


RESULTS
Over the total study period, mean SF-6D scores improved slightly from 0.78 at baseline to 0.80 at 2 years for patients who underwent cryostripping and from 0.77 to 0.79 for patients who underwent endovenous laser. QALY (SF-6D) was 1.59 in patients who underwent cryostripping and 1.60 in patients who underwent endovenous laser 2 years after treatment. The costs of cryostripping and endovenous laser per patient were euro 2651 and euro 2783, respectively. Bootstrapping indicated that cryostripping was associated with an incremental cost-effectiveness ratio of euro 32 per QALY gained. With regard to different strategies, outpatient cryostripping was less costly and more effective 2 years after treatment.


CONCLUSIONS
In this study, in terms of costs per QALY gained, outpatient cryostripping appeared to be the dominant strategy, but endovenous laser yielded comparable outcomes for a relatively little additional cost.
Disselhoff
B C V M
BC
Department of Surgery, Mesos Medical Centre, Van Heuven Goedhartlaan 1, 3527 Utrecht, CE, The Netherlands. disselhoff@planet.nl
Buskens
E
E
Kelder
J C
JC
der Kinderen
D J
DJ
Moll
F L
FL
D000328:Adult; D000368:Aged; D000556:Ambulatory Surgical Procedures; D003362:Cost-Benefit Analysis; D003452:Cryosurgery / Q000191:economics*; D005260:Female; D006801:Humans; D053685:Laser Therapy / Q000191:economics*; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D019057:Quality-Adjusted Life Years; D012501:Saphenous Vein / Q000601:surgery; D015911:Sclerotherapy; D014648:Varicose Veins / Q000191:economics* / Q000601:surgery*; D055815:Young Adult