OBJECTIVES: To compare the clinical- and cost-effectiveness of cyanoacrylate glue occlusion (CAE) with other technologies i.e. Surgical Treatment (ST), Ultrasound-Guided Foam Sclerotherapy (UGFS), Radiofrequency Ablation (RFA), Endovenous Laser Ablation (EVLA), and Mechanochemical Ablation (MOCA) in the management of Chronic Venous Insufficiency (CVI).

METHODS: A network meta-analysis (NMA) based on a systematic literature review, was used to derive the clinical effectiveness (Complete Success [CS]: anatomical closure of the target vein at month 3) of health technologies for the treatment of CVI. Based on NMA results, Markov cost-effectiveness model was developed to analyze the impact of CAE compared to other existing technologies on the overall disease management. Five years duration from the US payer perspective was considered for the analysis. Costs included in analysis were direct cost of treatment, cost related to adverse events, and loss of productivity. Outcomes were measured in terms of clinical success rates and quality of life improvement.

RESULTS: A total of 19 randomized controlled trials were included in the analysis based on inclusion criteria. Among the treatment options, the mean (95% CI) CS was highest for CAE: 0.98 (0.88-1.0), followed by RFA: 0.93 (0.86-0.97). For ST mean (95% CI) CS was 0.75 (0.67-0.82). EVLA and UGFS showed mean CS (95%CI) estimates 0.85 (0.75-0.91), 0.79 (0.68-0.87), respectively. MOCA mean CS (95% CI) estimates varied with Polidocanol concentration: 1% polidocanol had predicted mean of 0.30 (0.24-0.38) while 3% polidocanol had predicted mean of 0.86 (0.78-0.91). Based on preliminary analysis, CAE resulted in incremental cost-effectiveness ratio (ICER) of $1,285 compared to ST. This analysis showed that CAE was a cost-saving therapy compare to EVLA ($-47,566), UGFS ($-540,330), RFA ($-371,241), and MOCA+3% polidocanol ($-59,164).

CONCLUSIONS: Based on preliminary findings, use of CAE for the management of CVI is a cost-effective treatment. Assumptions along with sensitivity scenarios will be explored in further analyses.