Economics of Lymphovenous Bypass

Abstract

Background: The objective of this study was to compare the economic impact of complete decongestive therapy and lymphovenous bypass in the management of upper extremity lymphedema. Methods: Economics were modeled for a patient with breast cancer–related lymphedema undergoing three different clinical pathways: (1) complete decongestive therapy alone; (2) lymphovenous bypass no longer requiring ongoing complete decongestive therapy; or (3) lymphovenous bypass requiring ongoing complete decongestive therapy. Activity-based cost analysis identified costs incurred with complete decongestive therapy and lymphovenous bypass. Costs were retrieved from supplier price lists, physician fee schedules, lymphedema therapists, and literature reviews. The net present value of all costs incurred for each clinical pathway were calculated. Results: The estimated net present value of all costs for a patient with breast cancer–related lymphedema undergoing treatment were as follows: (1) complete decongestive therapy alone ($30,400); (2) lymphovenous bypass no longer requiring ongoing complete decongestive therapy ($15,000); or (3) lymphovenous bypass requiring ongoing complete decongestive therapy ($42,100). The expected net present value of all costs for lymphovenous bypass was $26,800, which was comparable to that of complete decongestive therapy alone. Sensitivity analysis demonstrated that the expected net present value of lymphovenous bypass was dependent on the patient’s life expectancy, number of bypass anastomoses, and likelihood of discontinuing complete decongestive therapy. Conclusions: Lymphedema has substantial ongoing costs irrespective of the treatment modality. The cost of lymphovenous bypass appears comparable to that of complete decongestive therapy alone—the surgical costs of lymphovenous bypass are offset by the savings from discontinued ongoing therapy. Despite its limitations as a theoretical economic model, this study provides insight into the potential economic impact of lymphovenous bypass.

Medicine and Phlebolymphology: Time to Change?

“…Economics of lymphatic microsurgery in breast cancer-related LYM were examined in a specific paper [148]. Notwithstanding a few possible criticisms concerning the authors' calculations of conservative treatment (probably overestimated) costs, overall microsurgery proved cost-effective when it was followed by discontinuation of ongoing conservative therapy, which is unlikely to occur in the vast majority of these patients who are affected by a life-long disease.…”

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

“…One Canadian study quantified the upfront costs of LVA and found that the total upfront cost of LVA is offset by the possible discontinuation of postoperative decompressive therapy. 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.…”

Eliminating the Burden of Lymphedema in Cancer Patients Requiring Nodal Dissections Using Prophylactic Immediate Lymphatic Reconstruction – A Case Report and Review of the Literature

“…This article also raises a potential economic benefit, through decreased healthcare costs, and improved productivity, and increase in QOL which could be interesting to elucidate further in future studies. 47 The limitations of this study include firstly that this is a report on a singular patient outcome, with no comparative arm. Another important limitation pertains to the method of LVA patency confirmation.…”