The role of cost-effectiveness for vascular surgery service provision in the United Kingdom.
OBJECTIVE
The cost of health care is increasingly becoming an international issue, with many health care systems requiring evaluation of cost when agreeing to fund health care. In the United Kingdom (UK), for example, the National Institute for Health and Care Excellence highlights the importance of using cost-effectiveness analyses to facilitate the effective use of resources. This study evaluates the use of cost-effectiveness analyses and the provision of vascular surgery.


METHODS
A systematic review of published literature was performed. UK-based studies assessing cost-effectiveness or cost-utility of superficial venous interventions, abdominal aortic aneurysm (AAA) repair, and carotid endarterectomy (CEA) were included. All included studies were quality assessed to determine the overall strength of UK economic evidence for each intervention.


RESULTS
Four superficial venous, six AAA, and two CEA studies met the inclusion criteria. After quality assessment, the UK evidence supporting the cost-effectiveness of superficial venous intervention was graded strong. The economic evidence for asymptomatic and symptomatic CEA was graded limited and insufficient, respectively, owing to a paucity of UK literature in this field. There was strong UK economic evidence affirming that endovascular aneurysm repair (EVAR) is unlikely to be a cost-effective alternative to open repair.


CONCLUSIONS
There is strong economic evidence for symptomatic superficial venous intervention. However, funding for varicose vein treatments remains controversial. Future economic analyses are required for symptomatic and asymptomatic CEA to better advise national policy. Despite strong economic evidence, current UK guidance is for EVAR over open repair in the elective setting, with the majority of elective AAA repairs being EVAR.
Academic Section of Vascular Surgery, Division of Surgery, Imperial College London, Charing Cross Hospital, London, United Kingdom. Electronic address: rishimandavia@gmail.com.
Rishi
R
Mandavia
Academic Section of Vascular Surgery, Division of Surgery, Imperial College London, Charing Cross Hospital, London, United Kingdom.
Brahman
B
Dharmarajah
Academic Section of Vascular Surgery, Division of Surgery, Imperial College London, Charing Cross Hospital, London, United Kingdom.
Mahim I
MI
Qureshi
Academic Section of Vascular Surgery, Division of Surgery, Imperial College London, Charing Cross Hospital, London, United Kingdom.
Alun H
AH
Davies
D017544:Aortic Aneurysm, Abdominal / Q000191:economics / Q000601:surgery; D003362:Cost-Benefit Analysis / Q000191:economics*; D016894:Endarterectomy, Carotid / Q000191:economics; D057510:Endovascular Procedures / Q000191:economics; D006801:Humans; D019458:Insurance Coverage / Q000191:economics; D013222:State Medicine / Q000191:economics*; D006113:United Kingdom; D014656:Vascular Surgical Procedures / Q000191:economics*