CLASS

CLASS:  Comparison of LAser, Surgery and foam Sclerotherapy: randomised controlled trial comparing foam sclerotherapy, alone or in combination with endovenous laser therapy, with conventional surgery as a treatment for varicose veins

A randomised controlled trial comparing foam sclerotherapy, alone or in combination with endovenous laser therapy, with conventional surgery as a treatment for varicose veins. The study involves participants from hospitals throughout the UK and in addition to clinical measures, NHS and patient costs were assessed, and QALYs were derived from responses to the EQ–5D and SF–36 at baseline, six weeks and six months. Given that the initial report was based on follow-up data to six months, results were extrapolated to a longer time horizon using an economic decision analytic model. 

Outcome and translation

The trial has now completed a period of extended follow-up to five years post randomisation. Results based on this extended follow-up are are now published, and suggest that laser has the highest probability of being cost-effective at thresholds commonly applied in the UK NHS. 

HERU researchers involved with this research project: Luke Vale, Graham Scotland, Emma Tassie and Maria Dimitrova

External Collaborators: J Brittenden, K Cassar, P Bachoo, J Norrie (School of Medicine, Medical Sciences and Nutrition, University of Aberdeen); MJ Gough, IAD Mavor, J Scott (University of Leeds); P McCollum (University of Hull); IC Chetter (Hull NHS Trust); J Burr, M Campbell and C Ramsay (HSRU, University of Aberdeen)

CLASS logoFurther details on this project are available on the Health Services Research Unit website.

Publications

Brittenden, J., Cotton, S. C., Elders, A., Tassie, E., Scotland, G., Ramsay, C., Norrie, J., Burr, J. M., Francis, J., S., W., Campbell, B., Bachoo, P., Chetter, I., Gough, M., Earnshaw, J., Lees, T., Scott, J., Baker, S. A., MacLennan, G., Prior, M., Bolsover, D. and Campbell, M. K. (2013) Clinical and cost-effectiveness of foam sclerotherapy, endovenous laser ablation and surgery for varicose veins: results from the CLASS trial. Final grant report submitted to the NIHR HTA Programme, University of Aberdeen: Health Services Research Unit.

Brittenden, J., Cotton, S. C., Elders, A., Ramsay, C. R., Norrie, J., Burr, J., Campbell, B., Bachoo, P., Chetter, I., Gough, M., Earnshaw, J., Lees, T., Scott, J., Baker, S. A., Francis, J., Tassie, E., Scotland, G., Wileman, S. and Campbell, M. K. (2014) 'A randomized trial comparing treatments for varicose veins', New England Journal of Medicine, 371(13), 1218-1227.

Tassie, E. , Scotland, G., Brittenden, J., Cotton, S. C., Elders, A., Campbell, M. K., Campbell, B., Gough, M., Burr, J. M., Ramsay, C. R. on behalf of the Class study team (2014) 'Cost-effectiveness of ultrasound-guided foam sclerotherapy, endovenous laser ablation or surgery as treatment for primary varicose veins from the randomized CLASS trial', British Journal of Surgery, 101(12), 1532-1540.

Brittenden, J., Cotton, S. C., Elders, A., Tassie, E., Scotland, G., Ramsay, C. R., Norrie, J., Burr, J., Francis, J., Wileman, S., Campbell, B., Bachoo, P., Chetter, I., Gough, M., Earnshaw, J., Lees, T., Scott, J., Baker, S. A., MacLennan, G., Prior, M., Bolsover, D. and Campbell, M. K. (2015) 'Clinical effectiveness and cost-effectiveness of foam sclerotherapy, endovenous laser ablation and surgery for varicose veins: results from the Comparison of LAser, Surgery and foam Sclerotherapy (CLASS) randomised controlled trial', Health Technology Assessment, 19(27).

Scotland, G. and Tassie, E. (2015) 'Cost-effectiveness of treatments for varicose veins', HERU Policy Brief, University of Aberdeen, April 2015.

Brittenden, J., Cooper, D., Dimitrova, M., Scotland, G., Cotton, S.C., Elders, A., MacLennan, G., Ramsay, C.R., Norrie, J., Burr, J.M., Campbell, B., Bachoo, P., Chetter, I., Gough, M., Earnshaw, J., Lees, T., Scott, J., Baker, S.A., Tassie, E., Francis, J. and Campbell, M.K. (2019) 'Five-year outcomes of a randomized trial of treatments for varicose veins', New England Journal of Medicine, 381(10), 912-922.

 

Presentations

Tassie, E. and Scotland, G. (2015) 'Characterising structural uncertainty arising from the use of a Markov model to extrapolate longer-term estimates of cost-effectiveness from short-term randomised data: a case study in the treatment of varicose veins', HTAi 2015. Global Efforts in Knowledge Transfer: HTA to Health Policy and Practice, Oslo, Norway, 15-17 June 2015.

Scotland, G. on behalf of the CLASS study team (2018) 'New evidence from the CLASS trial', Vascular Society Annual Scientific Meeting, Glasgow, 27-29 November 2018.