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Objective: Cost-effectiveness is a critical outcome when comparing different modality for treatment of varicose vein disease. Due to clinical equipoise and faster recovery, endovenous catheter ablation has become the treatment of choice over surgical intervention for the providers and their patients with chronic venous insufficiency.
Methods: A retrospective analysis of hospital and office costs was performed using the Current Procedural Terminology (CPT) coding on patients undergoing vein stripping of refluxing saphenous vein (CPT 37722), stab phlebectomy of varicosities (CPT 37765, 37766), endovenous radiofrequency ablation (RFA, CPT 36475), and endovenous laser ablation (EVLA, CPT 36478) between January 1, 2010 to December 31, 2011 at our community hospital and tertiary care institution. Costs were divided into charges, net revenue, total cost, variable cost, direct cost, variable contribution margin, program contribution margin, and profit or loss categories. All costs were normalized to 2010 and 2011 values.
Results: A total of 152 vein procedures in 2010 and 156 cases in 2011 were performed in an office-based setting at the tertiary institution; 73 vein procedures in 2010 and 71 cases in 2011 in the operating room at the community hospital. In 2010, higher costs per case were consistently seen in vein stripping [$5458] and vein ablation [$4884] performed in the operating room as compared to RFA [$1074] and EVLA [$1534] performed in the office (P<.001). Below is a table showing the net profit or loss (in parentheses) per case performed in the operating room versus the clinic setting:

	Operating Room-based Community Hospital				Office-based Tertiary Hospital
CPT		36475	37722	37765	36475	36478	37765	37766
Case		RFA	Stripping	Phlebectomy	RFA	EVLA	Phlebectomy	Phlebectomy
2010 $		(1123)	(798)	(1370)	845	835	932	978
2011 $		(496)	(585)	(363)	1011	711	1217	2137

Conclusions: Treatment of varicose vein disease with vein stripping surgery was associated with higher costs than RFA and EVLA of refluxing truncal veins. RFA procedures performed in the operating room are associated with net loss per case versus office-based interventions. At present, catheter-based interventions can be considered the preferred treatment and a cost-effective method for treating patients with chronic venous insufficiency and varicose veins.