title: A Cost-effectiveness Analysis of Surgery, Endothermal Ablation, Ultrasound-guided Foam Sclerotherapy and Compression Stockings for Symptomatic Varicose Veins.
abstract: OBJECTIVE
  The aim was to investigate the cost-effectiveness of interventional treatment for varicose veins (VV) in the UK NHS, and to inform the national clinical guideline on VV, published by the National Institute of Health and Care Excellence.
  
  
  METHODS
  An economic analysis was constructed to compare the cost-effectiveness of surgery, endothermal ablation (ETA), ultrasound-guided foam sclerotherapy (UGFS), and compression stockings (CS). The analysis was based on a Markov decision model, which was developed in consultation with members of the NICE guideline development group (GDG).
  
  
  METHODS
  The model had a 5-year time horizon, and took the perspective of the UK National Health Service. Clinical inputs were based on a network meta-analysis (NMA), informed by a systematic review of the clinical literature. Outcomes were expressed as costs and quality-adjusted life years (QALYs).
  
  
  RESULTS
  All interventional treatments were found to be cost-effective compared with CS at a cost-effectiveness threshold of £20,000 per QALY gained. ETA was found to be the most cost-effective strategy overall, with an incremental cost-effectiveness ratio of £3,161 per QALY gained compared with UGFS. Surgery and CS were dominated by ETA.
  
  
  CONCLUSIONS
  Interventional treatment for VV is cost-effective in the UK NHS. Specifically, based on current data, ETA is the most cost-effective treatment in people for whom it is suitable. The results of this research were used to inform recommendations within the NICE guideline on VV.
authors.affiliation: National Clinical Guideline Centre, Royal College of Physicians, London, UK. Electronic address: gmarsden@ohe.org.
authors.forename: G
authors.initials: G
authors.lastname: Marsden
authors.affiliation: National Clinical Guideline Centre, Royal College of Physicians, London, UK.
authors.forename: M
authors.initials: M
authors.lastname: Perry
authors.affiliation: University Department of Vascular Surgery, University of Birmingham, Solihull, UK.
authors.forename: A
authors.initials: A
authors.lastname: Bradbury
authors.affiliation: Worcestershire Royal Hospital, Worcester, UK.
authors.forename: N
authors.initials: N
authors.lastname: Hickey
authors.affiliation: National Clinical Guideline Centre, Royal College of Physicians, London, UK.
authors.forename: K
authors.initials: K
authors.lastname: Kelley
authors.affiliation: Sheffield Vascular Institute, Sheffield Teaching Hospital Foundation Trust, Sheffield, UK.
authors.forename: H
authors.initials: H
authors.lastname: Trender
authors.affiliation: National Clinical Guideline Centre, Royal College of Physicians, London, UK.
authors.forename: D
authors.initials: D
authors.lastname: Wonderling
authors.affiliation: Department of Surgery & Cancer, Imperial College & Imperial College NHS Trust, Charing Cross Hospital, London, UK.
authors.forename: A H
authors.initials: AH
authors.lastname: Davies
mesh_terms: D055011:Ablation Techniques / Q000009:adverse effects / Q000191:economics*; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D017048:Health Care Costs; D006801:Humans; D008390:Markov Chains; D018803:Models, Economic; D019057:Quality-Adjusted Life Years; D015911:Sclerotherapy / Q000009:adverse effects / Q000191:economics*; D013222:State Medicine / Q000191:economics; D053828:Stockings, Compression / Q000009:adverse effects / Q000191:economics*; D013997:Time Factors; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000009:adverse effects / Q000191:economics*; D006113:United Kingdom; D014648:Varicose Veins / Q000150:complications / Q000175:diagnosis / Q000191:economics* / Q000628:therapy*; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000191:economics*
keywords: Costs and cost analysis; Cost–benefit analysis; Quality-adjusted life years; Surgery; Varicose veins