Pharmacoeconomic study of various treatment options for superficial vein thrombophlebitis of lower extremities

Background. The superficial veins thrombophlebitis (SVT) of lower extremities treatment can include conservative therapy (pharmacotherapy), crossectomy and phlebectomy.  

Objective: рharmacoeconomic evaluation of pharmacotherapy, crossectomy (in combination with pharmacotherapy) and phlebectomy (in combination with pharmacotherapy) in patients with SVT of lower extremities.  

Material and methods. Pharmacoeconomic evaluation was carried out using cost-effectiveness analysis (CEA) by calculating the costeffectiveness ratio (CER). The relapse/progression of the disease within 3 months after the end of treatment, the dynamics of pain, psychological, physical, social factors and the visual analog scale (VAS) indicator were used as parameters of clinical effectiveness. To assess the reliability of the obtained results, a deterministic, multivariate sensitivity analysis was performed.  

Results. Considering part of patients without progression and relapse within 3 months after the end of therapy as an indicator of clinical effectiveness, it was found that median CER for pharmacotherapy (22069,01) was significantly lower than for crossectomy (83353,91) and phlebectomy (95702,96) (p=0,000). Also median CER for crossectomy technique was significantly lower than for phlebectomy (p=0,003). The CER values for the dynamics of pain, psychological, physical, social factors and VAS indicators were significantly lower for pharmacologic treatment than for crossectomy and phlebectomy. There were no statistically significant differences between CER values for crossectomy and phlebectomy.  

Conclusion. It was established that if there are no medical contraindications, it is economically feasible to carry out pharmacotherapy for SVT of lower extremities, which requires the lowest costs to achieve full recovery. The pharmacoeconomic efficiency of crossectomy and phlebectomy are comparable. 

1. Stojko Yu.M., Kirienko A.I., Iliukhin E.A., et al. Diagnostics and treatment of superficial trombophlebitis. Guidelines of the Russian Phlebological Association. Flebologiya. 2019; 13 (2): 78–97 (in Russ.). https://doi.org/10.17116/flebo20191302178.

2. Clinical guidelines “Phlebitis and thrombophlebitis of superficial vessels” (approved by the Ministry of Health of the Russian Federation, 2021). Available at: https://base.garant.ru/402793810/?ysclid=lcpuua4s9w465629817 (in Russ.) (accessed 10.01.2023).

3. Uporov М.М. The current state of treatment of superficial thrombophlebitis of lower extremities. Nauka molodykh (Eruditio Juvenium). 2022; 10 (4): 471–90 (in Russ.). https://doi.org/10.23888/HMJ2022104471-490.

4. Kalinin R.E., Suchkov I.A., Agapov A.B., et al. The effectiveness of compression therapy in the prevention of venous thromboembolic complications in patients with COVID-19. Russian Sklifosovsky Journal “Emergency Medical Care”. 2022; 11 (3): 436–43 (in Russ.). https://doi.org/10.23934/2223-9022-2022-11-3-436-443.

5. Kalinin R.E., Suchkov I.A., Kamaev A.A. Effectiveness of local treatment in patients with chronic venous disease. Flebologiya. 2021; 15 (4): 290–6 (in Russ.). https://doi.org/10.17116/flebo202115041290.

6. Clinical guidelines “Varicose veins of the lower extremities” (approved by the Ministry of Health of the Russian Federation, 2021). Available at: https://www.garant.ru/products/ipo/prime/doc/402776841/?ysclid=lcput0c3u9769255319 (in Russ.) (accessed 10.01.2023).

7. Kalinin R.E., Suchkov I.A., Maksaev D.A. Clinical effectiveness of bioflavonoids in the treatment of secondary lower limb lymphedema. I.P. Pavlov Russian Medical Biological Herald. 2021; 29 (2): 245–50 (in Russ.). https://doi.org/10.17816/PAVLOVJ63283.

8. Chronic Venous Diseases Treatment Register. Quality of life according to CIVIQ 20 veno-specific questionnaire. Available at: https://venousregistry.org/index.php?f=1&id=25 (in Russ.) (accessed 10.01.2023).

9. Judicial and regulatory acts of the Russian Federation. Visual-analog pain assessment scale (VAS). Available at: https://sudact.ru/law/klinicheskie-rekomendatsii-distoniia-utv-minzdravom-rossii/prilozhenie-g1-gn/prilozhenie-g2/?ysclid=lcpvdo6soc159539652 (in Russ.) (accessed 10.01.2023).

10. Yagudina R.I., Zinchuk I.Yu. Pharmacoeconomic study of skin tests in the diagnostics of tuberculosis infection. FARMAKOEKONOMIKA. Sovremennaya farmakoekonomika i farmakoepidemiologiya / FARMAKOEKONOMIKA. Modern Pharmacoeconomics and Pharmacoepidemiology. 2013; 6 (1): 11–5 (in Russ.).

11. Yagudina R.I., Kulikov A.Yu., Metelkin I.A. Methodology of cost-effectiveness analysis in conducting pharmacoeconomical research. FARMAKOEKONOMIKA. Sovremennaya farmakoekonomika i farmakoepidemiologiya / FARMAKOEKONOMIKA. Modern Pharmacoeconomics and Pharmacoepidemiology. 2012; 5 (4): 3–8 (in Russ.).

12. Price list for services provided by City Clinical Hospital of Emergency Medical Care. Available at: https://bsmp.medgis.ru/prais (in Russ.) (accessed 10.01.2023).

13. The State Register of maximum selling prices. Available at: https://grls.rosminzdrav.ru/pricelims.aspx (in Russ.) (accessed 10.01.2023).

14. Rathbun S.W., Aston C.E., Whitsett T.L. A randomized trial of dalteparin compared with ibuprofen for the treatment of superficial thrombophlebitis. Journal of Thrombosis and Haemostasis. 2012; 10 (5): 833-839. https://doi.org/10.1111/j.1538-7836.2012.04669.x.

15. Beyer-Westendorf J., Schellong S.M., Gerlach H., et al. Prevention of thromboembolic complications in patients with superficial-vein thrombosis given rivaroxaban or fondaparinux: the open-label, randomised, non-inferiority SURPRISE phase 3b trial. Lancet Haematol. 2017; 4 (3): е105–13. https://doi.org/10.1016/S2352-3026(17)30014-5.

16. Blondon M., Righini M., Bounameaux H., et al. Fondaparinux for isolated superficial vein thrombosis of the legs: a cost-effectiveness analysis. Chest. 2012; 141 (2): 321–9. https://doi.org/10.1378/chest.11-0625.