August 14, 2016
SVS and AVF Respond to Findings of MEDCAC Panel on Lower Extremity Chronic Venous Disease
August 15, 2016—The Society for Vascular Surgery (SVS) and the American Venous Forum (AVF) announced that vascular surgeons and vein specialists representing the two organizations presented their support for newer lower extremity chronic venous disease (LECVD) treatments at the July 20 Medicare Evidence Development & Coverage Advisory Committee (MEDCAC) panel hearing on treatment strategies for patients with LECVD. The meeting was part of a 2-year MEDCAC analysis of lower extremity vascular disease. The panel reviewed peripheral arterial disease in 2015.
The societies noted that in recent decades, the cost for treatment of all variations of LECVD has been estimated by the Agency for Healthcare Research & Quality to have increased from $150 million to $1 billion per year.
As reported on August 10, the MEDCAC panelists expressed low confidence in the sufficiency of evidence to support a recommendation for national CMS coverage of interventions to treat LECVD. The scores reflect the panelists’ opinion that more research is needed, especially in the Medicare population, stated SVS and AVF.
Peter Gloviczki, MD, Past President of both SVS and AVF, and Michael Dalsing, MD, Past President of the AVF, were two of the six presenters representing the coalition of SVS and AVF at the meeting. The team of presenting vascular surgeons and vein specialists from SVS and AVF believed that in most cases, the scenarios deserved somewhat higher scores than they received.
In the societies’ announcement, Dr. Gloviczki stated that although the panel’s confidence scores were lower than presenters would have expected, “Overall we are optimistic.”
Dr. Dalsing added that the panel reviewed randomized controlled trial data that do not necessarily reflect real world patient experiences. He commented, “We stressed the reality of care. The meta-analysis presented, and the panel discussion, had the luxury of dealing mainly with data that do not often reflect the patients we see in our practice with multiple risk factors.”
Lowell Kabnick, MD, President of the AVF, noted, “Not all medical treatment decisions require randomized controlled trials. Properly designed studies can answer many of the same questions.”
Dr. Kabnick continued, ”Many research trials are pending. We have entered into a new period where advanced technological intervention may be superior to the standard therapy. Many of these treatments have been decided by appropriate varicose vein trials; however, randomized controlled trials are ongoing to investigate preferable treatment for deep vein thrombosis (phlebitis-clots) and venous obstruction.”