Shepherd Amanda C, Ortega-Ortega Marta, Gohel Manj S, Epstein David, Brown Louise C, Davies Alun H
Academic Section of Vascular Surgery,Imperial College School of Medicine,Charing Cross Hospital.
Department of Applied Economics,University of
Int J Technol Assess Health Care. 2015 Jan;31(5):289-96. doi: 10.1017/S0266462315000537. Epub 2015 Dec 30.
Although the clinical benefits of endovenous thermal ablation are widely recognized, few studies have evaluated the health economic implications of different treatments. This study compares 6-month clinical outcomes and cost-effectiveness of endovenous laser ablation (EVLA) compared with radiofrequency ablation (RFA) in the setting of a randomized clinical trial.
Patients with symptomatic primary varicose veins were randomized to EVLA or RFA and followed up for 6 months to evaluate clinical improvements, health related quality of life (HRQOL) and cost-effectiveness.
A total of 131 patients were randomized, of which 110 attended 6-month follow-up (EVLA n = 54; RFA n = 56). Improvements in quality of life (AVVQ and SF-12v2) and Venous Clinical Severity Scores (VCSS) achieved at 6 weeks were maintained at 6 months, with no significant difference detected between treatment groups. There were no differences in treatment failure rates. There were small differences in favor of EVLA in terms of costs and 6-month HRQOL but these were not statistically significant. However, RFA is associated with less pain at up to 10 days.
EVLA and RFA result in comparable and significant gains in quality of life and clinical improvements at 6 months, compared with baseline values. EVLA is more likely to be cost-effective than RFA but absolute differences in costs and HRQOL are small.
尽管静脉内热消融的临床益处已得到广泛认可，但很少有研究评估不同治疗方法对健康经济的影响。本研究在一项随机临床试验中比较了静脉内激光消融术（EVLA）与射频消融术（RFA）的6个月临床疗效和成本效益。
将有症状的原发性静脉曲张患者随机分为EVLA组或RFA组，并随访6个月，以评估临床改善情况、健康相关生活质量（HRQOL）和成本效益。
共有131例患者被随机分组，其中110例参加了6个月的随访（EVLA组n = 54；RFA组n = 56）。6周时实现的生活质量改善（AVVQ和SF-12v2）和静脉临床严重程度评分（VCSS）在6个月时得以维持，各治疗组之间未检测到显著差异。治疗失败率无差异。在成本和6个月的HRQOL方面，EVLA有微小优势，但无统计学意义。然而，RFA在长达10天的时间内疼痛较轻。
与基线值相比，EVLA和RFA在6个月时均能使生活质量得到相当且显著的改善，并在临床方面取得进展。EVLA比RFA更有可能具有成本效益，但成本和HRQOL的绝对差异较小。
