title: Cost and effectiveness of laser with phlebectomies compared with foam sclerotherapy in superficial venous insufficiency. Early results of a randomised controlled trial.
abstract: OBJECTIVE
  Quantify endovenous laser ablation (EVLA) with concurrent phlebectomies and ultrasound-guided foam sclerotherapy (UGFS) in cost and effectiveness at 3 weeks and 3 months.
  
  
  METHODS
  Single-centre, prospective, randomised controlled trial.
  
  
  METHODS
  One hundred patients (100 legs), C(2-6), age 21-78, M:F 42:58, with primary varicose veins received either EVLA under local anaesthetic or UGFS.
  
  
  METHODS
  Assessments included duplex, Aberdeen varicose vein questionnaire (AVVQ), venous clinical severity score (VCSS), venous filling index (VFI), visual analogue 7-day pain score and analgesia requirements. Additional treatments with UGFS were performed, if required. Micro-costing, using individually timed treatments, was based on consumables, staff pay and overheads.
  
  
  RESULTS
  Changes in AVVQ, VCSS and VFI values (3 months) did not demonstrate any significant difference between groups. At 3 months, the above-knee GSV occlusion rate (without co-existing reflux) was not significantly different between the groups (74% vs 69%; EVLA vs UGFS; P = .596). Of the 9 haemodynamic failures in each group, 7 EVLA patients and 4 UGFS patients had co-existing cross-sectional above-knee GSV occlusion at some point. However, UGFS significantly outperformed EVLA in cost, treatment duration, pain, analgesia requirements and recovery.
  
  
  CONCLUSIONS
  UGFS is 3.15 times less expensive than EVLA (£230.24 vs £724.72) with comparable effectiveness but 56% (versus 6%) required additional foam (ISRCTN:03080206).
authors.affiliation: Josef Pflug Vascular Unit, Ealing Hospital & Imperial College, London SW7 2AZ, UK.
authors.forename: C R
authors.initials: CR
authors.lastname: Lattimer
authors.forename: M
authors.initials: M
authors.lastname: Azzam
authors.forename: E
authors.initials: E
authors.lastname: Kalodiki
authors.forename: E
authors.initials: E
authors.lastname: Shawish
authors.forename: P
authors.initials: P
authors.lastname: Trueman
authors.forename: G
authors.initials: G
authors.lastname: Geroulakos
mesh_terms: D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D053685:Laser Therapy / Q000191:economics; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012501:Saphenous Vein / Q000601:surgery*; D015911:Sclerotherapy / Q000191:economics; D016896:Treatment Outcome; D014648:Varicose Veins / Q000191:economics / Q000628:therapy*; D014689:Venous Insufficiency / Q000191:economics / Q000628:therapy*; D055815:Young Adult