Randomised clinical trial, observational study and assessment of cost-effectiveness of the treatment of varicose veins (REACTIV trial)

Abstract

Standard surgical treatment of varicose veins by saphenofemoral ligation, stripping and multiple phlebectomies is a clinically effective and cost-effective treatment for varicose veins, with an ICER well below the threshold normally considered appropriate for the funding of treatments within the NHS. Injection sclerotherapy also appears to be cost-effective, but produces less overall benefit, with a higher ICER than surgery for patients with superficial venous reflux. In minor varicose veins without reflux, sclerotherapy is likely to provide a small average benefit with acceptable cost-effectiveness. Research is needed into methods for accurate and acceptable utility evaluations for conditions with relatively minor effect on HRQoL and also for a validated and standardised method of classification for varicose veins.

Comparing ultrasound guided foam sclerotherapy with surgical treatment in patients of varicose veins

“…The M:F ratio found in our study is in sharp contrast to the ratio mentioned in most of the western literature, where more females were suffering from this disease. 8,11,12,18,21,26 However in the study conducted by Jain et al, 41 of the 42 patients were males; by Masuda et al 42 of the 68 patients were males. 12,13 Majority of our patients were young with a mean age of 35.32 years in both group.…”

“…11 Also comparing the local wound related complication in surgery group with work of Michaels JA et al who found wound related complication in only 2.4% of patients our study group had more of local wound related complications. 18 In our study complications in the foam sclerotherapy group were tolerable and transient like discomfort in walking, tenderness etc. and did not require any active intervention, which are again comparable to the published studies.…”

“…This is similar to many studies which have quoted a significantly less time in doing UGFS compared to surgery. 11,18,21,22 Complications Some complications were exclusive to surgery group and not seen on UGFS group. These included stitch infection in 3 (12%) patients, seroma in 3 (12%) and hematoma in 2 (8%) patients at 1 week follow up.…”

“…1 Over last several years attempts have been made to optimally treat this condition by conservative, surgical or minimally invasive techniques. They have been shown to control reflux and improve calf muscle pump function in the setting of CVI.…”

NICE’s Cost-Effectiveness Range: Should it be Lowered?

“…Hip [14] and knee [15] replacements, and hernia [16] and varicose vein [17] repair cost less than £10k per QALY gained. Elective procedures such as these are often first to be reduced when the NHS is short of resources.…”