Cost-effectiveness of endovenous laser ablation of the great saphenous vein in patients with uncomplicated primary varicosis

Thomas Luebke, Jan Brunkwall

Although widely applied, the cost-effectiveness of endovenous laser ablation (EVLT) for varicose veins has not been established. Cost-effectiveness analysis was performed on the evaluation of EVLT for the treatment of uncomplicated varicose veins by using published data from randomizd clinical trials regarding the costs and the quality of life. Incremental cost per quality-adjusted life year (QALY) gained at 6 months following treatment was calculated. Sensitivity analysis was carried out to investigate the uncertainty associated with the results of our analysis. Over the time horizon of 1-6 months, it was found that the incremental cost of EVLT compared with conventional surgery was €466.66 and the incremental effect was -0.007 QALY at 1 month, -0.0075 QALY at 3 months and 0.0 QALY at 6 months. This shows that the strategy "EVLT" was dominated by the strategy "HL/S" at any time point for the base cases analyses. The results of various alternative economic evaluations indicated that EVLT may be a potentially cost effective (i.e. incremental cost effectiveness ratio of between €12158.67 and €514721.67 per QALY, respectively) treatment option compared to conventional surgical treatment for varicose veins with a certainty between 54.9 and 98.8 %. For patients with uncomplicated varicose veins and evidence of saphenofemoral reflux, surgical treatment for varicose veins offers a robust health benefit for relatively less costs compared to EVLT.