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MEDCAC vote on lower-extremity treatments leaves experts disappointed, hopeful
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Six presenters from the coalition of the Society for Vascular Surgery and the American Venous Forum expressed disappointment, but acknowledged that more research is needed, at the results of a recent panel meeting of the Medicare Evidence Development & Coverage Advisory Committee of the CMS.
On eight questions regarding whether interventional techniques improved various venous conditions, the 12-member Medicare Evidence Development & Coverage Advisory Committee (MEDCAC) panel voted with low confidence on seven of eight counts and with moderate confidence on the other.
The lone moderate-confidence vote applied to patients who have varicose veins and/or other clinical symptoms of chronic venous insufficiency and who present with symptoms.
Coalition presenter Michael C. Dalsing, MD, professor of surgery, division of vascular surgery, Indiana University School of Medicine, Indianapolis, said there is much real-world data, but the panel relied heavily on the scarcer randomized controlled trial data.
“We stressed the reality of care,” Dalsing said in a press release. “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.”
Coalition presenter Peter Gloviczki, MD, the Joe M. and Ruth Roberts professor of surgery, chair emeritus, division of vascular and endovascular surgery, and director emeritus, Gonda Vascular Center, Mayo Clinic, said the latest techniques have improved outcomes and quality of life for patients
“Overall, we are optimistic,” he said in the release. Gloviczki noted that conditions brought on by lower-extremity chronic venous disease used to require painful surgery followed by a several-day hospital stay, but the current medical climate allows outpatient procedures with local anesthesia.
The MEDCAC meeting was part of a 2-year analysis of lower-extremity vascular disease. According to the Agency for Healthcare Research and Quality, the cost for treatment of all varieties of lower-extremity vascular disease has increased from $150 million to $1 billion per year. – by James Clark
Disclosure: Dalsing, Gloviczki and the standing members of the MEDCAC panel report no relevant financial disclosures.