Laser vs. foam for varicose veins

When researchers compared five-year quality-of-life outcomes and cost effectiveness of three varicose vein treatments - endovenous laser ablation, ultrasound-guided foam sclerotherapy and surgery - they found disease-specific quality of life was best after laser ablation or surgery, and laser ablation emerged as the most cost-effective option. That’s according to a large multicenter study published September 5, 2019, in the New England Journal of Medicine.

“… in all three groups, quality of life 5 years after treatment was improved from baseline,” the authors write.

Researchers conducted a randomized, controlled trial of 798 varicose vein patients at 11 centers in the United Kingdom. They compared disease-specific and general quality-of-life outcomes at five years, as well as procedure cost-effectiveness.

Of the 595 patients who completed quality-of-life questionnaires, disease-specific quality of life favored laser ablation and surgery more so than foam sclerotherapy. Generic quality of life measures were similar among the three treatment groups. And laser ablation had the highest chance of being cost-effective. The authors write that at a willingness-to-pay ratio threshold of $28,433 per quality-adjusted life-years, 77.2% of the cost effectiveness model iterations leaned toward laser ablation. A two-way comparison of foam sclerotherapy and surgery favored surgery in 54.5% of the model.

Follow-up studies looking at two and three years post varicose vein treatment suggest laser ablation, foam sclerotherapy and surgery have equivalent recurrence rates and quality of life.

At five years, these researchers found patients reported no recurrence of their varicose veins in 58% of the laser ablation group, 54% of the surgical group and 47% of the foam therapy group.

“The differences in quality of life observed in our study are likely to relate to the fact that the presence and extent of varicose veins at 5 years were less in the laser ablation and surgery groups than in the foam sclerotherapy group, because disease-specific quality of life has previously been shown to be worse among patients who have recurrent disease than among those who don’t,” the authors write.

On the other hand, 11% in the laser ablation group, 14% in the foam sclerotherapy group and 7% in the surgery group had further treatment, according to the paper.

Patient satisfaction was high in this trial, according to the authors, which could help to explain the lower reintervention rates in this trial compared to other studies.

Foam sclerotherapy could be an evolving area among varicose vein treatments. Italian researchers reported in a paper published October 22, 2019, in the journal Expert Review of Medical Devices that foam sclerotherapy is the most minimally invasive and cost-effective varicose vein procedure in the short term.

“Several different methods of foam preparation have been described in literature,” they write. “In general, the foam generation method may affect characteristics such as stability and bubble size distribution, which in turn affect the therapeutic action of foam itself. Therefore, the selection of a suitable foaming technique is of importance for treatment success. Future developments on foaming techniques are expected to make sclerotherapy, already an effective treatment, even safer and more versatile therapeutic procedure.”

Disclosures:

The authors report no relevant disclosures.