CLINICAL RESULTS AND COST EFFECTIVENESS OF RADIOFREQUENCY AND CYANOACRYLATE COMPARED WITH TRADITIONAL STRIPPING FOR TREATING VARICOSE VEINS.

BACKGROUND Disease of the venous system is an underappreciated public health problem. Minimally invasive treatments based on radiofrequency ablation (RFA) or cyano-acrylate adhesive ablation (CA) have almost entirely replaced surgical stripping (SS) of the great and small saphenous veins. OBJECTIVE The purpose of this study is to compare the outcome 3 years after SS, RFA, or CA by assessing complications and reintervention and performing a cost-effectiveness analysis. METHODS Between February 2016 and February 2019, all consecutive patients with symptomatic varicose veins from the Vascular Department of two hospitals who were treated with SS, RFA or CA were included in the study. The clinical outcomes were measured by quality-adjusted life years (QALYs), complications and reintervention. A comparison with conservative treatment was also performed. A detailed resource use was recorded for each procedure. All costs were normalized to May 2020 US dollars and euros. Analysis of the data was by treatment received. All statistical tests were two-sided, and the significance level was set at 5%. Two perspectives of the analysis were considered: the social perspective and that of the Spanish Public Health System (SPHS). The time horizon was 3 years. No discount rate was applied. RESULTS A total of 233 patients were enrolled in this study: 90 SS (38.6%), 93 RFA (39.9%), and 50 CA (21.5%). There were 11 complications in the SS group (12.2%) vs. 3 (3.3%) with RFA and 3 (6%) with CA (p = 0.06). There were no cases of reinterventions. The median loss of workdays was 15 days for SS (IQR 10-30), 0 days for RFA (IQR 0-6), and 0 for CA (IQR 0-1) groups, respectively (p < 0.001). The median level of satisfaction for SS was 9 (IQR 8-10), 10 for RFA (IQR 9-10), and also 10 for CA (IQR 9-10) (p < 0.001). The QALYs was 2.6 years for all three procedures. The medians overall cost is €852/US$926 for SS, €1002/US$1089 for RFA and €1228.3/US$1335 for CA. The total cost per QALY is 323 €/QALY (351US$/QALY) for SS; 380 €/QALY (413US$/QALY) for RFA and 467 €/QALY (508US$/QALY) for CA. Indirect cost was measured by workdays lost cost for each patient, for SS was €1527 (US$1660) (IQR 1018-3054); 0€ (IQR 0- 611) for RFA and 0€ (IQR 0-102) for CA (p < 0.001). CONCLUSIONS All three techniques were cost effective (procedures are recommended with an incremental cost-effectiveness ratio under 30,000€/QALY). From the SPHS perspective, when considering only health care costs, the most cost-effective technique was SS. From the social perspective, including the opportunity cost of medical leave, CA was the most cost-effective technique, saving €1600 per patient, a cost that more than compensates for the savings of SS in direct healthcare costs.