Cost-effectiveness of ultrasound-guided foam sclerotherapy, endovenous laser ablation or surgery as treatment for primary varicose veins from the randomized CLASS trial

E. Tassie; G. Scotland; J. Brittenden; S. C. Cotton; A. Elders; M. K. Campbell; B. Campbell; M. Gough; J. M. Burr; C. R. Ramsay; CLASS Study Team

doi:10.1002/bjs.9595

Cost-effectiveness of ultrasound-guided foam sclerotherapy, endovenous laser ablation or surgery as treatment for primary varicose veins from the randomized CLASS trial

E. Tassie^*, G. Scotland, J. Brittenden, S. C. Cotton, A. Elders, M. K. Campbell, B. Campbell, M. Gough, J. M. Burr, C. R. Ramsay, CLASS Study Team

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

32 Citations (Scopus)

Abstract

Background: The treatment of patients with varicose veins constitutes a considerable workload and financial burden to the National Health Service. This study aimed to assess the cost-effectiveness of ultrasound-guided foam sclerotherapy (UGFS) and endovenous laser ablation (EVLA) compared with conventional surgery as treatment for primary varicose veins.

Methods: Participant cost and utility data were collected alongside the UK CLASS multicentre randomized clinical trial, which compared EVLA, surgery and UGFS. Regression methods were used to estimate the effects of the alternative treatments on costs to the health service and quality-adjusted life-years (QALYs) at 6 months. A Markov model, incorporating available evidence on clinical recurrence rates, was developed to extrapolate the trial data over a 5-year time horizon.

Results: Compared with surgery at 6 months, UGFS and EVLA reducedmean costs to the health service by 655 pound and 160 pound respectively. When additional overhead costs associated with theatre use were included, these cost savings increased to 902 pound and 392 pound respectively. UGFS produced 0.005 fewer QALYs, whereas EVLA produced 0.011 additional QALYs. Extrapolating to 5 years, EVLA was associated with increased costs and QALYs compared with UGFS (costing 3640 pound per QALY gained), and generated a cost saving (206-439) pound and QALY gain (0.078) compared with surgery. Applying a ceiling willingness-to-pay ratio of 20 pound 000 per QALY gained, EVLA had the highest probability (78.7 per cent) of being cost-effective.

Conclusion: The results suggest, for patients considered eligible for all three treatment options, that EVLA has the highest probability of being cost-effective at accepted thresholds of willingness to pay per QALY.

Original language	English
Pages (from-to)	1532-1540
Number of pages	9
Journal	British Journal of Surgery
Volume	101
Issue number	12
Early online date	2 Oct 2014
DOIs	https://doi.org/10.1002/bjs.9595
Publication status	Published - Nov 2014

Bibliographical note

Acknowledgements
The authors thank the following contributors to the CLASS project for ongoing advice and support for the trial: J. Cruden, T. Davidson, J. Francis, A. McDonald, G. McPherson, S. Wileman, I. Chetter, J. J. Earnshaw, T. Lees, J. Scott, S. Baker, G. MacLennan, M. Prior and D. Bolsover. In addition, they thank J. Wallace, E. Wilson, S. Hardy, K. Hargreaves, D. Rittoo, S. Baker, L. Park, D. Parker, I. Chetter, J. Hatfield, J. Scott, N. Dewhirst, T. Lees, N. Parr, D. Dodd, J. Sorrell, K. R. Makhdoomi, B. Rorison, I. Nyamekye and P. Matheson for information on resource use and costs for treatment modalities at participating centres.

This work was carried out as part of a project funded by the National Institute for Health Research (NIHR) Health Technology Assessment (HTA) Programme (project number 06/45/02). The views and opinions expressed herein are those of the authors and do not necessarily reflect those of the NIHR HTA Programme, NIHR, NHS or Department of Health.

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10.1002/bjs.9595

Marion Campbell
- School of Medicine, Medical Sciences & Nutrition, Health Services Research Unit (HSRU) - Chair in HSRU
- Institute of Applied Health Sciences
Person: Academic
Seonaidh Cotton
- School of Medicine, Medical Sciences & Nutrition, Health Services Research Unit (HSRU) - Senior Trial Manager
- School of Medicine, Medical Sciences & Nutrition, Centre for Healthcare Randomised Trials (CHaRT)
Person: Academic Related - Management
Graham Scotland
- School of Medicine, Medical Sciences & Nutrition, Health Economics Research Unit - Personal Chair
- Institute of Applied Health Sciences
Person: Academic

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Tassie, E., Scotland, G., Brittenden, J., Cotton, S. C., Elders, A., Campbell, M. K., Campbell, B., Gough, M., Burr, J. M., Ramsay, C. R., & CLASS Study Team (2014). Cost-effectiveness of ultrasound-guided foam sclerotherapy, endovenous laser ablation or surgery as treatment for primary varicose veins from the randomized CLASS trial. British Journal of Surgery, 101(12), 1532-1540. https://doi.org/10.1002/bjs.9595

Tassie, E, Scotland, G, Brittenden, J, Cotton, SC, Elders, A, Campbell, MK, Campbell, B, Gough, M, Burr, JM, Ramsay, CR & CLASS Study Team 2014, 'Cost-effectiveness of ultrasound-guided foam sclerotherapy, endovenous laser ablation or surgery as treatment for primary varicose veins from the randomized CLASS trial', British Journal of Surgery, vol. 101, no. 12, pp. 1532-1540. https://doi.org/10.1002/bjs.9595

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title = "Cost-effectiveness of ultrasound-guided foam sclerotherapy, endovenous laser ablation or surgery as treatment for primary varicose veins from the randomized CLASS trial",

abstract = "Background: The treatment of patients with varicose veins constitutes a considerable workload and financial burden to the National Health Service. This study aimed to assess the cost-effectiveness of ultrasound-guided foam sclerotherapy (UGFS) and endovenous laser ablation (EVLA) compared with conventional surgery as treatment for primary varicose veins.Methods: Participant cost and utility data were collected alongside the UK CLASS multicentre randomized clinical trial, which compared EVLA, surgery and UGFS. Regression methods were used to estimate the effects of the alternative treatments on costs to the health service and quality-adjusted life-years (QALYs) at 6 months. A Markov model, incorporating available evidence on clinical recurrence rates, was developed to extrapolate the trial data over a 5-year time horizon.Results: Compared with surgery at 6 months, UGFS and EVLA reducedmean costs to the health service by 655 pound and 160 pound respectively. When additional overhead costs associated with theatre use were included, these cost savings increased to 902 pound and 392 pound respectively. UGFS produced 0.005 fewer QALYs, whereas EVLA produced 0.011 additional QALYs. Extrapolating to 5 years, EVLA was associated with increased costs and QALYs compared with UGFS (costing 3640 pound per QALY gained), and generated a cost saving (206-439) pound and QALY gain (0.078) compared with surgery. Applying a ceiling willingness-to-pay ratio of 20 pound 000 per QALY gained, EVLA had the highest probability (78.7 per cent) of being cost-effective.Conclusion: The results suggest, for patients considered eligible for all three treatment options, that EVLA has the highest probability of being cost-effective at accepted thresholds of willingness to pay per QALY.",

author = "E. Tassie and G. Scotland and J. Brittenden and Cotton, {S. C.} and A. Elders and Campbell, {M. K.} and B. Campbell and M. Gough and Burr, {J. M.} and Ramsay, {C. R.} and {CLASS Study Team}",

note = "Acknowledgements The authors thank the following contributors to the CLASS project for ongoing advice and support for the trial: J. Cruden, T. Davidson, J. Francis, A. McDonald, G. McPherson, S. Wileman, I. Chetter, J. J. Earnshaw, T. Lees, J. Scott, S. Baker, G. MacLennan, M. Prior and D. Bolsover. In addition, they thank J. Wallace, E. Wilson, S. Hardy, K. Hargreaves, D. Rittoo, S. Baker, L. Park, D. Parker, I. Chetter, J. Hatfield, J. Scott, N. Dewhirst, T. Lees, N. Parr, D. Dodd, J. Sorrell, K. R. Makhdoomi, B. Rorison, I. Nyamekye and P. Matheson for information on resource use and costs for treatment modalities at participating centres. This work was carried out as part of a project funded by the National Institute for Health Research (NIHR) Health Technology Assessment (HTA) Programme (project number 06/45/02). The views and opinions expressed herein are those of the authors and do not necessarily reflect those of the NIHR HTA Programme, NIHR, NHS or Department of Health.",

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T1 - Cost-effectiveness of ultrasound-guided foam sclerotherapy, endovenous laser ablation or surgery as treatment for primary varicose veins from the randomized CLASS trial

AU - Tassie, E.

AU - Scotland, G.

AU - Brittenden, J.

AU - Cotton, S. C.

AU - Elders, A.

AU - Campbell, M. K.

AU - Campbell, B.

AU - Gough, M.

AU - Burr, J. M.

AU - Ramsay, C. R.

AU - CLASS Study Team

N1 - Acknowledgements The authors thank the following contributors to the CLASS project for ongoing advice and support for the trial: J. Cruden, T. Davidson, J. Francis, A. McDonald, G. McPherson, S. Wileman, I. Chetter, J. J. Earnshaw, T. Lees, J. Scott, S. Baker, G. MacLennan, M. Prior and D. Bolsover. In addition, they thank J. Wallace, E. Wilson, S. Hardy, K. Hargreaves, D. Rittoo, S. Baker, L. Park, D. Parker, I. Chetter, J. Hatfield, J. Scott, N. Dewhirst, T. Lees, N. Parr, D. Dodd, J. Sorrell, K. R. Makhdoomi, B. Rorison, I. Nyamekye and P. Matheson for information on resource use and costs for treatment modalities at participating centres. This work was carried out as part of a project funded by the National Institute for Health Research (NIHR) Health Technology Assessment (HTA) Programme (project number 06/45/02). The views and opinions expressed herein are those of the authors and do not necessarily reflect those of the NIHR HTA Programme, NIHR, NHS or Department of Health.

PY - 2014/11

Y1 - 2014/11

N2 - Background: The treatment of patients with varicose veins constitutes a considerable workload and financial burden to the National Health Service. This study aimed to assess the cost-effectiveness of ultrasound-guided foam sclerotherapy (UGFS) and endovenous laser ablation (EVLA) compared with conventional surgery as treatment for primary varicose veins.Methods: Participant cost and utility data were collected alongside the UK CLASS multicentre randomized clinical trial, which compared EVLA, surgery and UGFS. Regression methods were used to estimate the effects of the alternative treatments on costs to the health service and quality-adjusted life-years (QALYs) at 6 months. A Markov model, incorporating available evidence on clinical recurrence rates, was developed to extrapolate the trial data over a 5-year time horizon.Results: Compared with surgery at 6 months, UGFS and EVLA reducedmean costs to the health service by 655 pound and 160 pound respectively. When additional overhead costs associated with theatre use were included, these cost savings increased to 902 pound and 392 pound respectively. UGFS produced 0.005 fewer QALYs, whereas EVLA produced 0.011 additional QALYs. Extrapolating to 5 years, EVLA was associated with increased costs and QALYs compared with UGFS (costing 3640 pound per QALY gained), and generated a cost saving (206-439) pound and QALY gain (0.078) compared with surgery. Applying a ceiling willingness-to-pay ratio of 20 pound 000 per QALY gained, EVLA had the highest probability (78.7 per cent) of being cost-effective.Conclusion: The results suggest, for patients considered eligible for all three treatment options, that EVLA has the highest probability of being cost-effective at accepted thresholds of willingness to pay per QALY.

AB - Background: The treatment of patients with varicose veins constitutes a considerable workload and financial burden to the National Health Service. This study aimed to assess the cost-effectiveness of ultrasound-guided foam sclerotherapy (UGFS) and endovenous laser ablation (EVLA) compared with conventional surgery as treatment for primary varicose veins.Methods: Participant cost and utility data were collected alongside the UK CLASS multicentre randomized clinical trial, which compared EVLA, surgery and UGFS. Regression methods were used to estimate the effects of the alternative treatments on costs to the health service and quality-adjusted life-years (QALYs) at 6 months. A Markov model, incorporating available evidence on clinical recurrence rates, was developed to extrapolate the trial data over a 5-year time horizon.Results: Compared with surgery at 6 months, UGFS and EVLA reducedmean costs to the health service by 655 pound and 160 pound respectively. When additional overhead costs associated with theatre use were included, these cost savings increased to 902 pound and 392 pound respectively. UGFS produced 0.005 fewer QALYs, whereas EVLA produced 0.011 additional QALYs. Extrapolating to 5 years, EVLA was associated with increased costs and QALYs compared with UGFS (costing 3640 pound per QALY gained), and generated a cost saving (206-439) pound and QALY gain (0.078) compared with surgery. Applying a ceiling willingness-to-pay ratio of 20 pound 000 per QALY gained, EVLA had the highest probability (78.7 per cent) of being cost-effective.Conclusion: The results suggest, for patients considered eligible for all three treatment options, that EVLA has the highest probability of being cost-effective at accepted thresholds of willingness to pay per QALY.

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JO - British Journal of Surgery

JF - British Journal of Surgery

IS - 12

ER -

Cost-effectiveness of ultrasound-guided foam sclerotherapy, endovenous laser ablation or surgery as treatment for primary varicose veins from the randomized CLASS trial

Abstract

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Marion Campbell

Seonaidh Cotton

Graham Scotland

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