Diagnostic et traitement des varices des membres inférieurs - KCE

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4 Varicose Veins KCE Reports 164 ABBREVIATIONS ASERNIP Australian Safety and Efficacy Register of New Interventional Procedures AVVQ Aberdeen Varicose Veins Questionnaire BLARA Bilateral varicose veins CEAP Clinical class, Etiology, Anatomy, Pathophysiology CHIVA Conservative Hemodynamic Management of Varicose Veins CIVIQ Chronic Venous Insufficiency Questionnaire CT Computed tomography CVD Chronic Venous Disease DET Data extraction table DUS Colour duplex ultrasonography/duplex scan DVT Deep vein thrombosis EVLT/ EVLA Endovenous laser therapy / ablation EQ-5D EuroQol – 5D (questionnaire) HAS Haute Autorité de Santé HHD or CADU Hand held Doppler or continuous-wave Doppler ultrasound INAHTA International Network of Agencies for Health Technology Assessment GA General anaesthesia GSV Great saphenous vein LA Local anaesthesia LSV long saphenous vein MDCT Multidetector computed tomography MHCS Modified Hollander Cosmetic Score MRI Magnetic resonance imaging NHS National Health Service (UK) NIHDI National Institute for Health and Disability Insurance NPV Negative predictive value PPV Positive predictive value QoL Quality of life RCT Randomised controlled trial RFA Radiofrequency Ablation SF-36 Short-form 36 (questionnaire) SFJ Saphenofemoral junction SFL/S Sapheno-femoral ligation and stripping SIGN Scottish Intercollegiate Guidelines Network SPJ Saphenopopliteal junction SR Systematic review SSV Small or Short saphenous vein TLA Tumescent Local Anaesthesia VAS Visual analogue scale VCSS Venous Clinical Severity Scores
KCE Reports 164 Varicose Veins 5 1 INTRODUCTION 1.1 BACKGROUND OF THE STUDY Diagnostic and therapeutic procedures for varicose veins rapidly evolved during the last decade. However billing codes used in Belgium are still based on the use of conventional techniques whilst new endovenous procedures are increasingly used 1 . 1.1.1 Necessary update of billing codes Data from the National Institute for Health and Disability Insurance (NIHDI) show disparities in the use of billing codes for anaesthetic as well as in diagnostic and therapeutic procedures 2 . For example, the annual number of interventions reimbursed based on the billing codes 589411-589422 2 (“percutaneous occlusion of arterial or venous vessels using medical imaging”) increased from 1 023 in 2005 to 8 772 in 2008. The use of this code later decreased following changes in the definition of this medical act. Currently there is no specific code for endovenous procedures. Haxhe et al. carried out a survey among members of the Belgian Society of vascular surgery 1 . They found a significant difference between the figures reported by the surgeons (33% endovascular techniques) versus official data from the NIHDI (18%). The authors interpreted this discrepancy by a sampling bias (52 out of 238 members) but also by the inappropriateness of the current billing codes to report the new endovenous techniques. The NIHDI statistics 2 also triggered a complementary question in relation to the type of anaesthesia used in the interventions for varicose veins. Nearly half of the billing codes for these interventions (42%) are coupled with a billing code for general anaesthesia, 15% have a billing code for locoregional anaesthesia and one third of the interventions combine codes for general and locoregional anaesthesia (36%). Billing codes for operating aid are reported in about 50% of the interventions. 1.1.2 Use of obsolete diagnostic techniques For diagnostic procedures a guideline has been elaborated by the Consilium Radiologicum and published on the website of the Federal Public service Health, Food security and Environment 3 . This guideline recommends the use of colour duplex Doppler ultrasound in most cases. Magnetic resonance imaging (MRI), tomography (and phlebography) might be used in exceptional cases (e.g. congenital abnormalities) before an intervention. The NIHDI subsequently sent a document to all physicians on the rational use of imaging procedures to decrease the risk linked to ionizing radiation4. Data illustrated e.g. the use of phlebography in 2008. They estimated the desirable reduction in use of phlebography in Belgium to be around 76%. The emergence of the new endovenous techniques, coupled with the uncertainty about the use of outdated billing codes, triggered the submission of a topic proposal to the KCE by the NIHDI. The objective of this research is to identify the best available evidence on the diagnosis and treatment of varicose veins of the lower limbs.
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Referen ce Martinez- Zapata 2008 89
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Dépôt légal : D/2011/10.273/51
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108. Le Tiotropium dans le traiteme
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Diagnostic et traitement des varices des membres inférieurs - KCE

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