Cost-effectiveness analysis of surgeryversus conservative treatment for uncomplicated varicose veins in a randomized clinical trial

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Abstract
Background: Despite being a common procedure, the cost effectiveness of surgery for varicose veins has not been established. Methods: Cost‐effectiveness analysis was carried out alongside a randomized clinical trial at two vascular units within National Health Service (NHS) hospitals. Some 246 patients with uncomplicated varicose veins and evidence of saphenofemoral or saphenopopliteal reflux were allocated randomly to receive either conservative management or surgical treatment. Incremental cost per quality‐adjusted life year (QALY) gained at 24 months following randomization was calculated. Results: Total NHS costs during the 2‐year study period were higher for the surgically treated group (£733) than for those who had conservative treatment (£345). The difference in costs was statistically significant. The mean incremental health gain from surgical treatment at 24 months was 0·083 QALYs, leading to a base‐case estimate of £4682 per QALY gained. Assuming an implicit threshold maximum willingness‐to‐pay value of £20 000 for a QALY, the probability of surgical treatment for varicose veins falling below this threshold value was 70 per cent. This result was found to be robust to sensitivity analysis. Conclusion: For patients with uncomplicated varicose veins and evidence of saphenofemoral or saphenopopliteal reflux, surgical treatment for varicose veins offers a modest health benefit for relatively little additional NHS cost relative to conservative treatment. Copyright © 2006 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.