Mallick Rajiv, Raju Aditya, Campbell Chelsey, Carlton Rashad, Wright David, Boswell Kimberly, Eaddy Michael
Senior Director, Health Economics and Outcomes Research, BTG International, West Conshohocken, PA, during this study.
Assistant Director, Xcenda, Palm Harbor, FL.
Am Health Drug Benefits. 2016 Nov;9(8):455-465.
Approximately 24% of adults in the United States have visible varicose veins, and an estimated 6% have evidence of advanced chronic venous disease. The majority of individuals with varicose veins seek treatment because of symptoms, such as aching, throbbing, fatigue, pruritus, ankle swelling, and tenderness, rather than cosmetic reasons. Furthermore, varicose veins are a manifestation of chronic venous insufficiency, which can progress to leg pain, leg edema, chronic skin changes, and nonhealing ulcers.
To assess varicose vein treatment patterns and their corresponding outcomes, including additional treatment rates, disease progression to new ulcers, and associated costs from a US perspective.
We conducted a retrospective claims database study using data from the Truven Health MarketScan database. Adults who were newly diagnosed with varicose veins between January 1, 2008, and June 30, 2010, and met the study inclusion criteria were eligible to participate and were divided into 6 cohorts based on the type of first or initial therapy they received after the index diagnosis date, including surveillance and compression therapy, surgery, laser ablation, radiofrequency ablation, sclerotherapy, or multiple therapies. The patients were followed for 2 years after the index diagnosis date to assess their treatment patterns and outcomes.
A total of 144,098 patients met the study criteria. Of these patients, 100,072 (69.5%) were under surveillance for disease progression and/or received compression therapy; 14,007 (9.7%) received laser ablation; 9125 (6.3%) received radiofrequency ablation; 4778 (3.3%) received sclerotherapy; 4851 (3.4%) had surgery; and 11,265 (7.8%) received multiple therapies. During the 2-year follow-up period, among patients receiving interventional treatment, 54.7% of patients received additional interventional treatment (either with the same mode or a different mode from the initial treatment); 30.1% had >1 postintervention claim for symptomatic varicose veins (not including additional procedures) at 8 weeks; and 44.2% had >1 postintervention claim for symptomatic varicose veins at 1 year after the initial interventional therapy.
A majority of the patients in the study received conservative management. For patients receiving interventional therapy, the outcomes varied based on the treatment cohort. The surgery cohort was associated with the most favorable outcome regarding the need for additional treatment and evidence of postintervention claims for symptomatic varicose veins, followed by the multiple therapies cohort. A better understanding of these treatment outcomes in the real-world setting may affect new strategies to improve the management of patients with varicose veins.
在美国，约24%的成年人有可见的静脉曲张，据估计6%有晚期慢性静脉疾病的迹象。大多数静脉曲张患者寻求治疗是因为症状，如疼痛、搏动、疲劳、瘙痒、脚踝肿胀和压痛，而非出于美容原因。此外，静脉曲张是慢性静脉功能不全的一种表现，可发展为腿痛、腿部水肿、慢性皮肤改变和不愈合溃疡。
从美国的角度评估静脉曲张的治疗模式及其相应结果，包括额外治疗率、疾病进展至新溃疡的情况以及相关费用。
我们使用Truven Health MarketScan数据库的数据进行了一项回顾性索赔数据库研究。2008年1月1日至2010年6月30日期间新诊断为静脉曲张且符合研究纳入标准的成年人有资格参与，并根据他们在索引诊断日期后接受的首次或初始治疗类型分为6个队列，包括监测和压迫治疗、手术、激光消融、射频消融、硬化疗法或多种治疗。在索引诊断日期后对患者进行了2年的随访，以评估他们的治疗模式和结果。
共有144,098名患者符合研究标准。在这些患者中，100,072名（69.5%）接受疾病进展监测和/或接受压迫治疗；14,007名（9.7%）接受激光消融；9125名（6.3%）接受射频消融；4778名（3.3%）接受硬化疗法；4851名（3.4%）接受手术；11,265名（7.8%）接受多种治疗。在2年的随访期内，接受介入治疗的患者中，54.7%的患者接受了额外的介入治疗（与初始治疗方式相同或不同）；30.0%的患者在8周时有>1次有症状静脉曲张的干预后索赔（不包括额外手术）；44.2%的患者在初始介入治疗后1年时有>1次有症状静脉曲张的干预后索赔。
研究中的大多数患者接受了保守治疗。对于接受介入治疗的患者，结果因治疗队列而异。手术队列在额外治疗需求和有症状静脉曲张的干预后索赔证据方面的结果最为有利，其次是多种治疗队列。在现实环境中更好地了解这些治疗结果可能会影响改善静脉曲张患者管理的新策略。
