Dr. John Happel | Aug 28, 2018 | 0
Learn How Varicose Veins are Treated Worldwide
Although doctors and patients in the United States often complain about our health care system, we should consider how good we have it in some regards.
To explore this concept, we need merely to compare how varicose veins are treated in this country and throughout the world. The American Recovery and Reinvestment Act of 2009 allocated $1.1 billion for cost effectiveness research. In 2010, U.S. health reform legislation established an ongoing national program in the Patient-Centered Outcomes Research Institute. Varicose vein treatment was examined closely because of the large number of patients with varicose veins.
They compared multiple strategies for treating varicose veins including traditional surgery, inpatient, day case, ultrasound guided sclerotherapy (injections), laser surgery, and conservative care with support stockings. Although ultrasound guided injections (sclerotherapy) had the lowest initial cost, but this was offset by high expected rates of retreatment needed as early as three months with its resulting increased cost burden to our health care system. Laser was approved as cost effective in our country when saphenous vein reflux is present (as is seen in most cases). In the final analysis, treatment selection is influenced by clinical outcomes, safety, literature and cost issues.
Let us examine other country’s approach to the problem in more detail. In Poland, no laser procedures for varicose veins are reimbursed. Only people who pay for the laser out of their own pocket are treated with laser. Stripping procedures are covered resulting in those traditional surgical treatments being performed there. In Austria, a similar scenario prevails. Although laser is available through insurance reimbursement, it is reimbursed at a much lower rate and the patient must also cover the costs of the laser materials so that stripping prevails through financial disincentives. In Sweden, the national health insurance covers only stripping operations done for massive saphenous vein reflux. Again traditional stripping prevails. In Germany, 95% of the population has general health insurance and stripping is reimbursed without any restrictions. Laser is only reimbursed by private insurance (5% of the population has private insurance) resulting in 95% of the German population getting stripping as their only choice for varicose veins. In Australia, laser is more accepted and laser can be performed but their insurance program only kicks in after expenses exceed $1500 and charges can reach up to $2500 per laser procedure. In France, injections alone are the main treatment option for varicose veins and reimbursed at 40 Euros per session. Laser is not reimbursed and thus not widely practiced so most patients who are referred to surgeons receive stripping.
Luckily in the U.S., stripping is being done less and less resulting in this painful procedure being restricted to rural areas and smaller hospitals where the laser approach has not yet penetrated. We are fortunate that our health care systems supports laser treatment of varicose veins. Laser has no scarring, is less invasive, less painful, safer, and has superior long term results. If you have any questions about laser for varicose veins, call us at 724-969-0600.