This study analyzed the cost-effectiveness of different interventions for varicose veins in the UK, including surgery, endovenous ablation (ETA), foam sclerotherapy (UGFS), and compression stockings (CS). The analysis found that all interventional treatments were cost-effective compared to CS alone using a threshold of £20,000 per QALY. ETA had the lowest probability of clinical recurrence per month and was the most cost-effective treatment overall, with an incremental cost-effectiveness ratio of £3,161 per QALY gained compared to the next best alternative. The results informed recommendations in the UK National Institute for Health and Care Excellence clinical guideline on varicose veins treatment.

1. A cost-effectiveness analysis of interventions for symptomatic varicose veins
G Marsden, MSc; M Perry, PhD; A Bradbury, FRCS; N Hickey, FRCS; K Kelley, PhD; H Trender, RGN; D Wonderling, MSc; A H Davies, FRCS
1. BACKGROUND
There has been great regional variation across the UK in how, and if, VV are treated. This economic analysis formed part of the NICE clinical guideline on VV (CG168). It was conducted to investigate whether such treatments should be recommended across the UK.
Acknowledgements & Funding This work was undertaken by the National Clinical Guideline Centre, which received funding from the National Institute for Health and Clinical Excellence (NICE). The views expressed in this publication are those of the authors and not necessarily of the institute.
2. METHODS
Comparators: surgery, endodermal ablation (ETA), foam sclerotherapy (UGFS), compression stockings (CS) Analyses: Systematic review, network meta analysis (NMA) and Markov decision model Time horizon: 5 years Perspective: UK NHS Outcomes: costs and quality adjusted life years (QALYs).
3.RESULTS
Cost-effectiveness analysis: All interventional treatments were found to be cost- effective compared to CS (threshold £20,000/QALY)
4. DISCUSSION
The model is based upon the treatment of unilateral GSV VVs; by logical extension the guideline development group expected that these results would hold for the treatment of the short saphenous vein, and also for bilateral treatment The model assumes that the patient can be treated by all four modalities, which may rarely be the case The quantity and quality of data available for the NMA were limited, particularly for UGFS, for which only two trials were included.
5. CONCLUSION
Interventional treatment for VV is cost-effective in the UK NHS. 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.
NMA diagram:
outcome = probability of clinical recurrence
(number of included studies in parenthesis)
Treatment
Probability of clinical recurrence per month (SD)
Surgery
0.0083 (0.0031)
ETA
0.0058 (0.0134)
UGFS
0.0091 (0.0037)
CS
NA
ETA
UGFS
Surgery
(1)
(7)
(2)
NMA results table:
ICER = £3,161 per QALY gained
Contact: gmarsden@ohe.org
ETA has lowest monthly probability of clinical recurrence
ETA was the most cost-effective strategy overall; Surgery and CS were dominated by ETA.