Guide
Laser, radiofrequency or foam: what each costs and involves
Updated
Three procedures dominate varicose vein treatment in the UK. They are priced differently because they are different, and NICE has an order of preference for them.
What NICE says the order should be
NICE clinical guideline CG168 on varicose veins states that for people with confirmed varicose veins and truncal reflux clinicians should offer endothermal ablation; if endothermal ablation is unsuitable, offer ultrasound-guided foam sclerotherapy; and if foam sclerotherapy is unsuitable, offer surgery. It also says duplex ultrasound should be used to confirm the diagnosis and the extent of truncal reflux and to plan treatment (NICE CG168, published 24 July 2013).
What each involves, in the NHS's description
- Endothermal ablation
- The NHS calls this usually the first choice of treatment. You are normally awake with a local anaesthetic, a catheter is passed up the vein from a small cut at the ankle or knee under ultrasound guidance, and radio waves or a laser heat and close the vein. Done in a hospital or clinic, home the same day, compression stockings for about a week, and the NHS says you should be able to return to most usual activities straight away.
- Foam sclerotherapy
- The NHS says this is usually offered if endothermal ablation is not suitable. You are awake with a local anaesthetic and a chemical mixed with air is injected into the vein under ultrasound guidance to block it. Home the same day, compression stockings for about a week.
- Ligation and stripping
- Surgery, offered by the NHS where the simpler procedures are not suitable. Usually done under general anaesthetic through a cut in the groin and a second lower down, with the vein pulled out on a wire. Usually home the same day, some pain and bruising for a few weeks, and the NHS says you may need 1 to 2 weeks off work.
- Compression stockings
- The NHS says these are only offered for varicose veins if procedures or surgery are unsuitable, or if you do not need other treatment. NICE goes further and says not to offer compression hosiery to treat varicose veins unless interventional treatment is unsuitable.
How the published prices line up with that
| Procedure | Cheapest published figure we found | Provider |
|---|---|---|
| Foam sclerotherapy | £1,349 | Practice Plus Group, fixed |
| Laser ablation | £1,795 | Practice Plus Group, fixed |
| Radiofrequency ablation | £3,149 | Practice Plus Group, fixed |
| Vein injections, minor | £399 | Practice Plus Group, fixed |
The cheapest published procedure is not the one NICE puts first, which is worth noticing. Foam sclerotherapy is published below endothermal ablation by both providers that list them side by side, and NICE positions it second for clinical reasons rather than commercial ones. A clinic recommending the cheaper option should be able to explain why in clinical terms.
NICE also advises that people are told new varicose veins may develop after treatment, that more than one session may be needed, and that recurrence after treatment for recurrent varicose veins is more likely than for primary ones. Ask what a second session would cost before you commit to the first.