OBJECTIVES Treatment of varicose veins (VV) has been shown to increase health related quality of life. However, the cost-effectiveness of such treatments has been uncertain. Indeed there is great regional variation across the UK in how, and if, VV are treated. This economic analysis formed part of the NICE clinical guideline on VV, with an objective to investigate whether such treatments should be recommended across the UK.  METHODS An economic analysis was conducted to compare the cost-effectiveness of surgery, endodermal ablation (ETA), ultrasound guided foam sclerotherapy (UGFS) and compression stockings (CS). The analysis was based on a Markov decision model, which was developed in consultation with members of the NICE guideline development group (GDG). The model had a five year time horizon, and took the perspective of the UK National Health Service. Clinical inputs were based on a network meta-analysis (NMA), informed by a systematic review of the clinical literature. Outcomes were expressed as costs and quality adjusted life years (QALYs). RESULTS All interventional treatments were found to be cost-effective compared to CS at a cost- effectiveness threshold of £20,000 per QALY gained. ETA was found to be the most cost-effective strategy overall, with an incremental cost-effectiveness ratio of £3,161 per QALY gained compared to UGFS. Surgery and CS were dominated by ETA. CONCLUSIONS Interventional treatment for VV is cost-effective in the UK NHS. Specifically, based on current data, ETA is the most cost-effective treatment in people for whom it is suitable. The results of this research were used to inform recommendations within the NICE guideline on VV. Funding: This work was undertaken by the National Clinical Guideline Centre, which received funding from the National Institute for Health and Clinical Excellence (NICE). The views expressed in this publication are those of the authors and not necessarily of the institute