title: The impact of 2013 UK NICE guidelines on the management of varicose veins at the Heart of England NHS Foundation Trust, Birmingham, UK.
abstract: OBJECTIVE
  Although varicose veins are a common cause of morbidity, the UK National Health Service and private medical insurers have previously sought to ration their treatment in a non-evidence based manner in order to limit health-care expenditure and reimbursement. In July 2013, the UK National Institute for Health and Care Excellence published new national Clinical Guidelines (CG168) to promote evidence-based commissioning and management of varicose veins. The aim of this study was to evaluate the impact of CG168 on the referral and management of varicose veins at the Heart of England NHS Foundation Trust, Birmingham, UK.
  
  
  METHODS
  Interrogation of a prospectively gathered database, provided by the Heart of England NHS Foundation Trust Performance Unit, of patients undergoing interventions for varicose veins since 1 January 2012. Patients treated before (group 1) and after (group 2) publication of CG168 were compared.
  
  
  RESULTS
  There were 253 patients, 286 legs (48% male, mean (range) age 54 (20-91) years) treated in group 1, and 417 patients, 452 legs, (46% male, mean (range) age 54 (14-90) years) treated in group 2, an increase of 65%. CG168 was associated with a significant reduction in the use of surgery (131 patients (52%) group 1 vs. 127 patients (30%) group 2, p = 0.0003, χ(2)), no change in endothermal ablation (30 patients (12%) group 1 vs. 45 patients (11%) group 2), a significant increase in ultrasound-guided foam sclerotherapy (92 patients (36%) group 1 and 245 patients (59%) group 2, p = 0.0001, χ(2)) and an increase in treatment for C2/3 disease (53% group 1 and 65.2% group 2, p = 0.0022, χ(2)).
  
  
  CONCLUSIONS
  Publication of National Institute for Health and Care Excellence CG168 has been associated with a significant increase (65%) in the number of patients treated, referral at an earlier (CEAP C) stage and increased use of endovenous treatment. CG 168 has been highly effective in improving access to, and quality of care, for varicose veins at Heart of England NHS Foundation Trust.
authors.affiliation: Department of Vascular Surgery, University of Birmingham, Solihull Hospital, Birmingham, UK huw.davies@heartofengland.nhs.uk.
authors.forename: Huw Ob
authors.initials: HO
authors.lastname: Davies
authors.affiliation: Department of Vascular Surgery, University of Birmingham, Solihull Hospital, Birmingham, UK.
authors.forename: Matthew
authors.initials: M
authors.lastname: Popplewell
authors.affiliation: Department of Vascular Surgery, University of Birmingham, Solihull Hospital, Birmingham, UK.
authors.forename: Gareth
authors.initials: G
authors.lastname: Bate
authors.affiliation: Department of Vascular Surgery, University of Birmingham, Solihull Hospital, Birmingham, UK.
authors.forename: Lisa
authors.initials: L
authors.lastname: Kelly
authors.affiliation: North Devon District Hospital, Barnstaple, Devon, UK.
authors.forename: Katy
authors.initials: K
authors.lastname: Darvall
authors.affiliation: Department of Vascular Surgery, University of Birmingham, Solihull Hospital, Birmingham, UK.
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Bradbury
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D006113:United Kingdom / Q000453:epidemiology; D014648:Varicose Veins / Q000453:epidemiology / Q000628:therapy*
keywords: NICE; Varicose veins; endovenous ablation; foam sclerotherapy; guidelines