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

Luebke T, Brunkwall J - BMC Cardiovasc Disord (2015)

Bottom Line: 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 %.

View Article: PubMed Central - PubMed

Affiliation: Department of Vascular and Endovascular Surgery, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germay. Thomas.luebke@uk-koeln.de.

ABSTRACT

Background: Although widely applied, the cost-effectiveness of endovenous laser ablation (EVLT) for varicose veins has not been established.

Methods: 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.

Results: 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 %.

Conclusion: 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.

No MeSH data available.


Related in: MedlinePlus

a Base case 1: Cost-effectiveness acceptability curve. The graph gives the probability that HL/S (87 %) or EVLT (13 %) would be considered cost effective for a €50000 threshold of willingness to pay. b Monte Carlo simulation of EVLT vs. HL/S A 10,000-iteration Monte Carlo simulation of a patient undergoing EVLT. The incremental cost and incremental effectiveness of EVLT compared with HL/S is plotted for each iteration. Of 10000.00 iterations, 5090.00 showed HL/S to be optimal by possessing ICERs below the €50,000/QALY threshold (northwest quadrant)
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Fig2: a Base case 1: Cost-effectiveness acceptability curve. The graph gives the probability that HL/S (87 %) or EVLT (13 %) would be considered cost effective for a €50000 threshold of willingness to pay. b Monte Carlo simulation of EVLT vs. HL/S A 10,000-iteration Monte Carlo simulation of a patient undergoing EVLT. The incremental cost and incremental effectiveness of EVLT compared with HL/S is plotted for each iteration. Of 10000.00 iterations, 5090.00 showed HL/S to be optimal by possessing ICERs below the €50,000/QALY threshold (northwest quadrant)

Mentions: The 10000-iteration Monte Carlo simulation for the base case analysis after 1 month is shown in the acceptability curve ICER scatter plot in Fig. 2a, b, c. The ellipse encloses 95 % of the model recalculations; the dotted-diagonal line represents the cost-effectiveness threshold, plotted at € 50,000/QALY, which is commonly applied in the published literature. In 50.9 % of model recalculations, HL/S dominates EVLT (less costly and more effective), in 36.6 % of model recalculations, EVLT is more costly and effective, but its ICER is greater than the willingness to pay (WTP), so HL/S is optimal, and in 12.49 % of model recalculations, EVLT is more costly and effective, and its ICER is less than or equal to the WTP. Consequently, EVLT is cost-effective, with 12.49 % certainty at a threshold of € 50,000/QALY in our base case 1. For the base case analysis 2 after 3 months, the 10,000-iteration Monte Carlo simulation is shown in the acceptability curve and ICER scatter plot in Fig. 3a, b, c. In 89.72 % of model recalculations, HL/S dominates EVLT (less costly and more effective), in 36.6 % of model recalculations, EVLT is more costly and effective, but its ICER is greater than the WTP, so HL/S is optimal, and in 0.46 % of model recalculations, EVLT is more costly and effective, and its ICER is less than or equal to the WTP. Consequently, EVLT is cost-effective, with 0.46 % certainty at a threshold of € 50,000/QALY in our base case 2.>Fig. 2


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

Luebke T, Brunkwall J - BMC Cardiovasc Disord (2015)

a Base case 1: Cost-effectiveness acceptability curve. The graph gives the probability that HL/S (87 %) or EVLT (13 %) would be considered cost effective for a €50000 threshold of willingness to pay. b Monte Carlo simulation of EVLT vs. HL/S A 10,000-iteration Monte Carlo simulation of a patient undergoing EVLT. The incremental cost and incremental effectiveness of EVLT compared with HL/S is plotted for each iteration. Of 10000.00 iterations, 5090.00 showed HL/S to be optimal by possessing ICERs below the €50,000/QALY threshold (northwest quadrant)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4625802&req=5

Fig2: a Base case 1: Cost-effectiveness acceptability curve. The graph gives the probability that HL/S (87 %) or EVLT (13 %) would be considered cost effective for a €50000 threshold of willingness to pay. b Monte Carlo simulation of EVLT vs. HL/S A 10,000-iteration Monte Carlo simulation of a patient undergoing EVLT. The incremental cost and incremental effectiveness of EVLT compared with HL/S is plotted for each iteration. Of 10000.00 iterations, 5090.00 showed HL/S to be optimal by possessing ICERs below the €50,000/QALY threshold (northwest quadrant)
Mentions: The 10000-iteration Monte Carlo simulation for the base case analysis after 1 month is shown in the acceptability curve ICER scatter plot in Fig. 2a, b, c. The ellipse encloses 95 % of the model recalculations; the dotted-diagonal line represents the cost-effectiveness threshold, plotted at € 50,000/QALY, which is commonly applied in the published literature. In 50.9 % of model recalculations, HL/S dominates EVLT (less costly and more effective), in 36.6 % of model recalculations, EVLT is more costly and effective, but its ICER is greater than the willingness to pay (WTP), so HL/S is optimal, and in 12.49 % of model recalculations, EVLT is more costly and effective, and its ICER is less than or equal to the WTP. Consequently, EVLT is cost-effective, with 12.49 % certainty at a threshold of € 50,000/QALY in our base case 1. For the base case analysis 2 after 3 months, the 10,000-iteration Monte Carlo simulation is shown in the acceptability curve and ICER scatter plot in Fig. 3a, b, c. In 89.72 % of model recalculations, HL/S dominates EVLT (less costly and more effective), in 36.6 % of model recalculations, EVLT is more costly and effective, but its ICER is greater than the WTP, so HL/S is optimal, and in 0.46 % of model recalculations, EVLT is more costly and effective, and its ICER is less than or equal to the WTP. Consequently, EVLT is cost-effective, with 0.46 % certainty at a threshold of € 50,000/QALY in our base case 2.>Fig. 2

Bottom Line: 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 %.

View Article: PubMed Central - PubMed

Affiliation: Department of Vascular and Endovascular Surgery, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germay. Thomas.luebke@uk-koeln.de.

ABSTRACT

Background: Although widely applied, the cost-effectiveness of endovenous laser ablation (EVLT) for varicose veins has not been established.

Methods: 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.

Results: 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 %.

Conclusion: 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.

No MeSH data available.


Related in: MedlinePlus