BACKGROUND AND PURPOSE:

• Two recommended non-surgical treatment options for varicose veins include
  • Endovenous laser ablation | Ultrasound-guided foam sclerotherapy
• Brittenden et al. (NEJM, 2019) assessed the long-term quality of life and cost-effectiveness outcomes of the above treatments and surgical therapy over 5 years

METHODS:

• Multicenter, randomized controlled trial (RCT)
• Participants
  • Primary symptomatic varicose veins > 3 mm diameter in one or both legs
• Groups
  • Laser ablation
  • Foam sclerotherapy
  • Surgery
• The Aberdeen Varicose Vein Questionnaire was used to assess quality of life
  • Scores range from 0 to 100 (lower scores indicating a better quality of life)
• Primary outcome
  • Disease-specific quality of life | Generic quality of life at 5 years
  • Cost-effectiveness
    • Based on models of expected costs and quality-adjusted life-years (QALYs) gained (using data on participants’ treatment costs and scores on the EuroQol EQ-5D questionnaire)

RESULTS:

• 798 total study participants | 75% completed quality-of-life questionnaires
• Disease-specific quality of life measures
  • Quality of life was improved for women in all groups  
  • Better scores for laser ablation or surgery vs foam sclerotherapy
    • Effect size (adjusted differences between groups) for laser ablation vs. foam sclerotherapy: −2.86 (95% CI, −4.49 to −1.22; P<0.001)
    • Effect size for surgery vs. foam sclerotherapy: −2.60 (95% CI, −3.99 to −1.22; P<0.001)
• Generic quality-of-life measures
  • No difference between groups
• Cost-effectiveness
  • 77.2% of the cost-effectiveness model iterations favored laser ablation, based on £20,000 ($28,433 in U.S. dollars) per QALY
  • 54.5% of the model iterations favored surgery when compared to foam sclerotherapy

CONCLUSION:

• At 5 years after treatment, laser ablation was comparable to surgery and both resulted in better quality of life scores compared to foam sclerotherapy
• Laser therapy was likely to be the most cost-effective in the majority of models

Learn More – Primary Sources:

Five-Year Outcomes of a Randomized Trial of Treatments for Varicose Veins

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