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Five-year outcomes of a randomized trial of treatments for varicose veins
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dc.contributor.author | Brittenden, Julie | |
dc.contributor.author | Cooper, David | |
dc.contributor.author | Dimitrova, Maria | |
dc.contributor.author | Scotland, Graham | |
dc.contributor.author | Cotton, Seonaidh C. | |
dc.contributor.author | Elders, Andrew | |
dc.contributor.author | MacLennan, Graeme | |
dc.contributor.author | Ramsay, Craig R. | |
dc.contributor.author | Norrie, John | |
dc.contributor.author | Burr, Jennifer M. | |
dc.contributor.author | Campbell, Bruce | |
dc.contributor.author | Bachoo, Paul | |
dc.contributor.author | Chetter, Ian | |
dc.contributor.author | Gough, Michael | |
dc.contributor.author | Earnshaw, Jonothan | |
dc.contributor.author | Lees, Tim | |
dc.contributor.author | Scott, Julian | |
dc.contributor.author | Baker, Sara A. | |
dc.contributor.author | Tassie, Emma | |
dc.contributor.author | Francis, Jill | |
dc.contributor.author | Campbell, Marion K | |
dc.date.accessioned | 2020-03-05T00:32:03Z | |
dc.date.available | 2020-03-05T00:32:03Z | |
dc.date.issued | 2019-09-05 | |
dc.identifier | 259018139 | |
dc.identifier | 14c51f00-dbfb-4404-946a-b98fa7933bce | |
dc.identifier | 85071738130 | |
dc.identifier | 000485326200006 | |
dc.identifier.citation | Brittenden , J , Cooper , D , Dimitrova , M , Scotland , G , Cotton , S C , Elders , A , MacLennan , G , Ramsay , C R , Norrie , J , Burr , J M , Campbell , B , Bachoo , P , Chetter , I , Gough , M , Earnshaw , J , Lees , T , Scott , J , Baker , S A , Tassie , E , Francis , J & Campbell , M K 2019 , ' Five-year outcomes of a randomized trial of treatments for varicose veins ' , New England Journal of Medicine , vol. 381 , pp. 912-922 . https://doi.org/10.1056/NEJMoa1805186 | en |
dc.identifier.issn | 0028-4793 | |
dc.identifier.other | ORCID: /0000-0002-9478-738X/work/61622221 | |
dc.identifier.uri | https://hdl.handle.net/10023/19602 | |
dc.description | Funded by the Health Technology Assessment Programme of the National Institute for Health Research; Current Controlled Trials number, ISRCTN51995477. | en |
dc.description.abstract | Background : Endovenous laser ablation and ultrasound-guided foam sclerotherapy are recommended alternatives to surgery for the treatment of primary varicose veins, but their long-term comparative effectiveness remains uncertain. Methods : In a randomized, controlled trial involving 798 participants with primary varicose veins at 11 centers in the United Kingdom, we compared the outcomes of laser ablation, foam sclerotherapy, and surgery. Primary outcomes at 5 years were disease-specific quality of life and generic quality of life, as well as cost-effectiveness based on models of expected costs and quality-adjusted life-years (QALYs) gained that used data on participants’ treatment costs and scores on the EuroQol EQ-5D questionnaire. Results : Quality-of-life questionnaires were completed by 595 (75%) of the 798 trial participants. After adjustment for baseline scores and other covariates, scores on the Aberdeen Varicose Vein Questionnaire (on which scores range from 0 to 100, with lower scores indicating a better quality of life) were lower among patients who underwent laser ablation or surgery than among those who underwent foam sclerotherapy (effect size [adjusted differences between groups] for laser ablation vs. foam sclerotherapy, −2.86; 95% confidence interval [CI], −4.49 to −1.22; P<0.001; and for surgery vs. foam sclerotherapy, −2.60; 95% CI, −3.99 to −1.22; P<0.001). Generic quality-of-life measures did not differ among treatment groups. At a threshold willingness-to-pay ratio of £20,000 ($28,433 in U.S. dollars) per QALY, 77.2% of the cost-effectiveness model iterations favored laser ablation. In a two-way comparison between foam sclerotherapy and surgery, 54.5% of the model iterations favored surgery. Conclusions : In a randomized trial of treatments for varicose veins, disease-specific quality of life 5 years after treatment was better after laser ablation or surgery than after foam sclerotherapy. The majority of the probabilistic cost-effectiveness model iterations favored laser ablation at a willingness-to-pay ratio of £20,000 ($28,433) per QALY. | |
dc.format.extent | 306115 | |
dc.language.iso | eng | |
dc.relation.ispartof | New England Journal of Medicine | en |
dc.subject | RD Surgery | en |
dc.subject | RM Therapeutics. Pharmacology | en |
dc.subject | 3rd-DAS | en |
dc.subject | BDC | en |
dc.subject | R2C | en |
dc.subject | ~DC~ | en |
dc.subject.lcc | RD | en |
dc.subject.lcc | RM | en |
dc.title | Five-year outcomes of a randomized trial of treatments for varicose veins | en |
dc.type | Journal article | en |
dc.contributor.institution | University of St Andrews. Population and Behavioural Science Division | en |
dc.contributor.institution | University of St Andrews. School of Medicine | en |
dc.identifier.doi | 10.1056/NEJMoa1805186 | |
dc.description.status | Peer reviewed | en |
dc.date.embargoedUntil | 2020-03-05 |
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