Varicose Vein Treatments Are Bargain for UK Health System

An analysis of varicose vein treatments common in the United Kingdom found that the therapies improve patients' quality of life and are a good investment of health resources.

The study combined a clinical trial with economic modeling to test the medical and cost-effectiveness of surgery and an injection treatment called sclerotherapy.

"The conclusion is that if you look at varicose vein treatments in the same sort of terms that we use to assess something like cancer drugs, then it would appear that varicose vein treatment is actually very cost-effective, and quite a good way to use your money," said lead researcher Jonathan Michaels, a professor of vascular surgery at the University of Sheffield in England.

The review is published in the latest issue of Health Technology Assessment, the international journal series of the Health Technology Assessment program of the National Health Service for the United Kingdom.

The analysis was prompted by the unique problems of the publicly funded U.K. health care system, and uses that country's cost assumptions. But the research may also provide guidance for American medical practice, where sclerotherapy is gaining in popularity as a varicose vein treatment.

Varicose veins are enlarged, sometimes twisted veins just under the skin caused by a faulty valve that allows a backflow of blood. The condition, which often appears in the legs, can be cosmetically troubling for patients or progress to cause symptoms like heaviness, itching or even a breakdown of the skin.

In the United Kingdom, the high demand for varicose vein treatment has led to some "rationing" of therapy and long health-service waiting lists, Michaels said.

"There are a lot of questions about whether minor conditions like varicose veins should really be treated on the NHS when there are competing demands for expensive treatments for more serious diseases, such as cancer," he said.

Those questions have created an ethical debate about how and where to invest health care resources, he added. Michaels' technology cost assessment suggests that varicose vein treatment is a good buy.

The study tested the varicose vein treatments for three different groups - patients with mild, moderate and severe varicose veins.

Only the third patient group, of people with severe varicose veins, was large enough show a definitive treatment advantage. Surgery outperformed conservative management, providing the greatest improvements in quality of life, symptoms and patient satisfaction.

Varicose vein surgeries vary, but in a common technique called "ligation and stripping" the defective vein is tied off then removed. Conservative management is a range of measures to care for varicose veins, which can include education and reassurance, advice to elevate the legs or the use of compression stockings.