An economic analysis of prophylactic lymphovenous anastomosis among breast cancer patients receiving mastectomy with axillary lymph node dissection

Squitieri, Lee; Rasmussen, Petra W.; Patel, Ketan M.

doi:10.1002/jso.25902

Cited by 26 publications

(22 citation statements)

References 5 publications

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“… 46 In our results, AlJindan et al 15 reported that all patients were able to discontinue decompressive therapy postoperatively, whereas Ayestaray et al 23 found this was only true in 30% of patients. Similarly, one study found that ILR results in a greater than 40% cost saving in patients undergoing mastectomy with ALND, 47 as the lifetime cost of lymphedema treatment surpass the upfront cost of ILR.…”

Section: Discussionmentioning

confidence: 96%

Outcomes of Lymphovenous Anastomosis for Upper Extremity Lymphedema: A Systematic Review

Gupta

Verhey

Torres

et al. 2021

Plastic and Reconstructive Surgery - Global Open

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Background: Lymphovenous anastomosis (LVA) is an accepted microsurgical treatment for lymphedema of the upper extremity (UE). This study summarizes and analyzes recent data on the outcomes associated with LVA for UE lymphedema at varying degrees of severity. Methods: A literature search was conducted in the PubMed database to extract articles published through June 19, 2020. Studies reporting data on postoperative improvement in limb circumference/volume or subjective improvement in quality of life for patients with primary or secondary lymphedema of the UE were included. Extracted data consisted of demographic data, number of patients and upper limbs, duration of symptoms before LVA, surgical technique, follow-up, and objective and subjective outcomes. Results: A total of 92 articles were identified, of which 16 studies were eligible for final inclusion comprising a total of 349 patients and 244 upper limbs. The average age of patients ranged from 38.4 to 64 years. The duration of lymphedema before LVA ranged from 9 months to 7 years. The mean length of follow-up ranged from 6 months to 8 years. Fourteen studies reported an objective improvement in limb circumference or volume measurements following LVA, ranging from 0% to 100%. Patients included had varying severity of lymphedema, ranging from Campisi stage I to IV. The maximal improvement in objective measurements was found in patients with lower stage lymphedema. Conclusion: LVA is a safe, effective technique for the treatment of UE lymphedema refractory to decompressive treatment. Results of LVA indicate greater efficacy in earlier stages of lymphedema before advanced lymphatic sclerosis.

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Section: Discussionmentioning

confidence: 96%

Outcomes of Lymphovenous Anastomosis for Upper Extremity Lymphedema: A Systematic Review

Gupta

Verhey

Torres

et al. 2021

Plastic and Reconstructive Surgery - Global Open

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“…This sum represented 42% of the total cost per patient in whom no prophylactic intervention was performed. 70 Likewise, in a cost-utility analysis presented by Johnson et al, immediate lymphatic reconstruction after ALND was more cost-effective in comparison to ALND alone, with an incremental cost-utility ratio of $1587.73 per quality-adjusted life year. 71 Similarly, in patients undergoing RLNR, the incorporation of immediate lymphatic reconstruction provided an incremental cost-utility ratio of $699.84 per quality-adjusted life year.…”

Section: Discussionmentioning

confidence: 97%

Primary Prevention of Cancer-Related Lymphedema Using Preventive Lymphatic Surgery: Systematic Review and Meta-analysis

Ciudad

Escandón

Bustos

et al. 2022

Indian J Plast Surg

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Background Several studies have proven prophylactic lymphovenous anastomosis (LVA) performed after lymphadenectomy can potentially reduce the risk of cancer-related lymphedema (CRL) without compromising the oncological treatment. We present a systematic review of the current evidence on the primary prevention of CRL using preventive lymphatic surgery (PLS). Patients and Methods A comprehensive search across PubMed, Cochrane-EBMR, Web of Science, Ovid Medline (R) and in-process, SCOPUS, and ScienceDirect was performed through December 2020. A meta-analysis with a random-effect method was accomplished. Results Twenty-four studies including 1547 patients fulfilled the inclusion criteria. Overall, 830 prophylactic LVA procedures were performed after oncological treatment, of which 61 developed lymphedema.The pooled cumulative rate of upper extremity lymphedema after axillary lymph node dissection (ALND) and PLS was 5.15% (95% CI, 2.9%–7.5%; p < 0.01). The pooled cumulative rate of lower extremity lymphedema after oncological surgical treatment and PLS was 6.66% (95% CI < 1–13.4%, p-value = 0.5). Pooled analysis showed that PLS reduced the incidence of upper and lower limb lymphedema after lymph node dissection by 18.7 per 100 patients treated (risk difference [RD] – 18.7%, 95% CI – 29.5% to – 7.9%; p < 0.001) and by 30.3 per 100 patients treated (RD – 30.3%, 95% CI – 46.5% to – 14%; p < 0.001), respectively, versus no prophylactic lymphatic reconstruction. Conclusions Low-quality studies and a high risk of bias halt the formulating of strong recommendations in favor of PLS, despite preliminary reports theoretically indicating that the inclusion of PLS may significantly decrease the incidence of CRL.

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“…They predicted that if all patients underwent prophylactic bypass, regardless of if the patient developed lymphedema, there was $7646 cost savings (45.2% in their treatment) per patient through limitation of annual medical therapy. 23 …”

Section: Discussionmentioning

confidence: 99%

Single Center Retrospective Analysis of Cost and Payments for Lymphatic Surgery

Tom

Boudiab

Issa

et al. 2021

Plastic and Reconstructive Surgery - Global Open

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Background: Insurance coverage for microsurgical lymphatic surgery continues to be sporadic, as the procedures continue to be labeled investigational. The objective of this study was to examine the typical payment patterns of our clinical practice for microsurgical lymphatic procedures. Methods: We performed a single center, single surgeon retrospective case review for all lymphovenous bypass and vascularized lymph node transfer cases preformed from 2018 to 2020. We then queried the available financial data and calculated total charges, total paid by insurance, total variable cost (cost to the hospital), and the contribution margin (difference between the amount paid and variable cost). Descriptive statistics were then collected for each subgroup for analysis. Results: Financial data were collected on 22 patients with 10 left-sided, 11 right-sided and one bilateral procedure performed. Seven procedures were done prophylactically, and 15 were done for existing lymphedema. An estimated 10 of 22 patients (45%) had Medicare, Medicaid, or Tricare, with the remaining having private insurance. We calculated an average cost of $48,516.73, with average payment of $10,818.68, average variable cost of $5,567.10, for a contribution margin of +$5251.58. Conclusions: Lymphedema remains a common complication of surgery and a significant cost burden to patients and the healthcare system. Microsurgical procedures offer several advantages over medical therapy. In our practice, we were routinely reimbursed for both prophylactic and therapeutic procedures with positive contribution margins for the hospital and ratios similar to other surgeries. Despite the limitations of a small retrospective review, there is no similar published cost analysis data in the current literature.

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An economic analysis of prophylactic lymphovenous anastomosis among breast cancer patients receiving mastectomy with axillary lymph node dissection

Cited by 26 publications

References 5 publications

Outcomes of Lymphovenous Anastomosis for Upper Extremity Lymphedema: A Systematic Review

Outcomes of Lymphovenous Anastomosis for Upper Extremity Lymphedema: A Systematic Review

Primary Prevention of Cancer-Related Lymphedema Using Preventive Lymphatic Surgery: Systematic Review and Meta-analysis

Single Center Retrospective Analysis of Cost and Payments for Lymphatic Surgery

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