Effectiveness of treatments of varicose veins. Systematic review and evidence synthesis

David Epstein, Sarah Onida, Roshan Bootun, Marta Ortega-Ortega and Alun Davies
Additional contact information
Sarah Onida: Imperial College of Science, Technology and Medicine, London, United Kingdom
Roshan Bootun: Imperial College of Science, Technology and Medicine, London, United Kingdom
Marta Ortega-Ortega: Universidad de Granada. Spain. Applied Economic Department
Alun Davies: Imperial College of Science, Technology and Medicine, London, United Kingdom

No 01/16, FEG Working Paper Series from Faculty of Economics and Business (University of Granada)

Abstract: Objectives. This paper conducts a systematic review and network meta-analysis of current and emerging technologies for treatment of varicose veins. Design. We compare the effectiveness of current technologies - conservative care, surgery, ultrasound guided foam sclerotherapy (UGFS), endovenous laser ablation (EVLA), and radiofrequency ablation (RFA) – with emerging technologies–mechanochemical ablation (MOCA) and cyanoacrylate glue occlusion (CAE). Methods. A systematic review of the literature was conducted. For current technologies the review only considers evidence from RCTs. Evidence from non-randomised studies was included in a secondary analysis. Outcomes were re-intervention on the truncal vein and health-related quality of life (HRQOL) measured by Aberdeen Varicose Vein Questionnaire (AVVQ) and EQ-5D. Results. The rate of re-interventions on the truncal vein is similar between EVLA, RFA and surgery, while greater for UGFS and conservative care. HRQOL is similar at 1-13 weeks between surgery, EVLA, RFA, MOCA and CAE. HRQOL is similar between surgery, EVLA, RFA at longer term follow-up from 6 months to 5 years. UGFS is associated with lower HRQOL than EVLA measured by EQ-5D at short term and long term follow-ups. Non-randomised studies indicate the rate re-intervention after MOCA might be similar to other interventions but there are insufficient published data to draw definite conclusions. Conclusions. This study is the first systematic review that has conducted a meta-analysis of reintervention. The main risk of bias in the RCTs appears to be the high rate of attrition. High quality studies comparing MOCA and CAE to other modalities are needed.

Keywords: : Varicose veins; systematic review; literature review; meta-analysis; re-intervention; re-treatment (search for similar items in EconPapers)
Pages: 40 pages
Date: 2016-10-11
References: View complete reference list from CitEc
Citations:

Downloads: (external link)
http://www.ugr.es/~teoriahe/RePEc/gra/fegper/FEGWP0116.pdf (application/pdf)

Related works:
This item may be available elsewhere in EconPapers: Search for items with the same title.

Export reference: BibTeX RIS (EndNote, ProCite, RefMan) HTML/Text

Persistent link: https://EconPapers.repec.org/RePEc:gra:fegper:01/16

Access Statistics for this paper

More papers in FEG Working Paper Series from Faculty of Economics and Business (University of Granada) Campus Universitario de Cartuja. Contact information at EDIRC.
Bibliographic data for series maintained by Juliette Milgram Baleix. ().