Cost‐effectiveness analysis of a randomized clinical trial of early versus deferred endovenous ablation of superficial venous reflux in patients with venous ulceration.
Published: 11th February 2019
Authors: D. M. Epstein, M. S. Gohel, F. Heatley, X. Liu, A. Bradbury, R. Bulbulia et al.
Treatment of superficial venous reflux in addition to compression therapy accelerates venous leg ulcer healing and reduces ulcer recurrence. The aim of this study was to evaluate the costs and cost‐effectiveness of early versus delayed endovenous treatment of patients with venous leg ulcers.
This was a within‐trial cost‐utility analysis with a 1‐year time horizon using data from the EVRA (Early Venous Reflux Ablation) trial. The study compared early versus deferred endovenous ablation for superficial venous truncal reflux in patients with a venous leg ulcer. The outcome measure was the cost per quality‐adjusted life‐year (QALY) over 1 year. Sensitivity analyses were conducted with alternative methods of handling missing data, alternative preference weights for health‐related quality of life, and per protocol.
After early intervention, the mean(s.e.m.) cost was higher (difference in cost per patient £163(318) (€184(358))) and early intervention was associated with more QALYs at 1 year (mean(s.e.m.) difference 0·041(0·017)). The incremental cost‐effectiveness ratio (ICER) was £3976 (€4482) per QALY. There was an 89 per cent probability that early venous intervention is cost‐effective at a threshold of £20 000 (€22 546)/QALY. Sensitivity analyses produced similar results, confirming that early treatment of superficial reflux is highly likely to be cost‐effective.
Early treatment of superficial reflux is highly likely to be cost‐effective in patients with venous leg ulcers over 1 year. Registration number: ISRCTN02335796 (
You may also be interested in
Authors: R. Svensson‐Björk, M. Zarrouk, G. Asciutto, J. Hasselmann, S. Acosta
Cost‐effectiveness of targeted screening for abdominal aortic aneurysm in siblings. BJS 2019; 106: 206-216.
Authors: R. Hultgren, A. Linné, S. Svensjö
Notes: Cost effective
Authors: M. A. Waduud, B. Wood, P. Keleabetswe, J. Manning, E. Linton, M. Drozd et al.
Systematic review of endovascular intervention and surgery for common femoral artery atherosclerotic disease. BJS 2019; 106: 13-22.
Authors: X. Jia, Z. D. Sun, J. V. Patel, K. Flood, D. D. Stocken, D. J. A. Scott et al.
Sex differences in national rates of repair of emergency abdominal aortic aneurysm. BJS 2019; 106: 82-89.
Authors: A. Aber, T. S. Tong, J. Chilcott, P. Thokala, R. Maheswaran, S. M. Thomas et al.
Notes: Why worse for women?
Randomized clinical trial
Cost‐effectiveness of revascularization in patients with intermittent claudication. BJS 2018; 105: 1742-1748.
Authors: H. Djerf, M. Falkenberg, L. Jivegård, H. Lindgren, M. Svensson, J. Nordanstig et al.
Notes: Revascularization effective but pricey
Systematic review of the safety and efficacy of osseointegration prosthesis after limb amputation. BJS 2018; 105: 1731-1741.
Authors: S. K. Kunutsor, D. Gillatt, A. W. Blom
Notes: Technology with potential
Local anaesthesia for endovascular repair of ruptured abdominal aortic aneurysm. BJS 2019; 106: 74-81.
Authors: R. Mouton, C. A. Rogers, R. A. Harris, R. J. Hinchliffe
Notes: Improves 30‐day survival
Authors: H. Shiwani, P. Baxter, E. Taylor, M. A. Bailey, D. J. A. Scott
Long‐term outcomes of endovenous laser ablation and conventional surgery for great saphenous varicose veins. BJS 2018; 105: 1759-1767.
Authors: T. Wallace, J. El‐Sheikha, S. Nandhra, C. Leung, A. Mohamed, A. Harwood et al.
Notes: Lower recurrence at 5 years after laser
Authors: A. J. A. Meershoek, G. J. de Borst
Predicting risk of rupture and rupture‐preventing reinterventions following endovascular abdominal aortic aneurysm repair. BJS 2018; 105: 1294-1304.
Authors: I. Grootes, J. K. Barrett, P. Ulug, F. Rohlffs, S. J. Laukontaus, R. Tulamo et al.
Notes: Potential to tailor surveillance