Financial Burden of Lymphedema Hospitalizations in the United States

Abstract

Lymphedema, characterized by disruptions to the flow of lymphatic fluid, commonly occurs in cancer survivors and has been linked to increased depression, anxiety, pain, and low healthrelated quality of life. 1 Although there is no curative treatment, patients with lymphedema may receive outpatient care to help mitigate symptoms and reduce disease progression. 2 Without proper management, lymphedema can progress to recurrent cellulitis and hospitalization. The objective of this cohort study was to identify factors associated with high costs during lymphedema-related hospitalizations.Methods | We used the Healthcare Cost and Utilization Project National Inpatient Sample to identify lymphedema-related hospitalizations. 3 All hospitalizations for lymphedema and lymphedema-associated cellulitis were included by identifying adult patients (≥18 years old) who were admitted between January 1, 2012, and December 31, 2017, with (1) a primary diagnosis of lymphedema or (2) a primary diagnosis of cellulitis with a secondary diagnosis of lymphedema. Hospitalizations were classified by disease site (upper vs lower extremity). Among patients admitted for cellulitis, codes specified the disease site; in patients admitted for lymphedema, codes specified the disease site as postmastectomy (upper extremity) or other (lower extremity). International Classification of Diseases, and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) codes were used for site specification. Cost to charge ratios were used to estimate reimbursed hospitalization costs. This study was considered exempt by the University of North Carolina institutional review board because the database conforms to the definition of a limited data set and no informed consent is necessary for publicly available data sets. This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline.The statistical analysis was performed between January 4 and June 30, 2020. Multivariable logistic regression analysis was used to estimate the association between patient, disease, and hospital characteristics and extreme costs. Extreme costs were defined as those in the top 20th percentile of costs. Multivariable generalized gamma regression analy-

A non-randomized, open-label study of the safety and effectiveness of a novel non-pneumatic compression device (NPCD) for lower limb lymphedema

“…Lymphedema results in significant healthcare costs. It has been estimated that between 2012 and 2017, more than $1B was spent on lymphedema-related hospitalizations; often hospitalizations involving the lower extremities are more costly than those for upper extremities 11 . The physical limitations imposed by LEL have been shown to increase the likelihood of needing assistance with activities of daily living 12 , which can impose significant costs to patients.…”

Various Therapies for Lymphedema and Chronic Venous Insufficiency, Including a Multimodal At-Home Nonpneumatic Compression Treatment

“…The financial and personal burdens of chronic edema have been linked to increased depression, anxiety, and pain, and low health-related quality of life. 8 Lymphedema remains an incurable, lifelong chronic disease, and patients face increasing out-of-pocket costs. Proper management of lymphedema has lasting impacts on lowering an individual's healthcare expenditures, increasing productivity, and reducing episodic clinical deterioration from cellulitis and resultant hospitalization.…”

“…Proper management of lymphedema has lasting impacts on lowering an individual's healthcare expenditures, increasing productivity, and reducing episodic clinical deterioration from cellulitis and resultant hospitalization. 8,9 From 2012 through 2017, lymphedema-related hospitalizations resulted in more than $1 billion of reimbursed costs in the US healthcare system. 8 A consensus from The American Venous Forum, the American Vein and Lymphatic Society, and the Society for Vascular Medicine published in 2022 by Lurie et al 7 and a systematic review by Torgbenu et al 10 both recommend early intervention for the management of lymphedema.…”

“…8,9 From 2012 through 2017, lymphedema-related hospitalizations resulted in more than $1 billion of reimbursed costs in the US healthcare system. 8 A consensus from The American Venous Forum, the American Vein and Lymphatic Society, and the Society for Vascular Medicine published in 2022 by Lurie et al 7 and a systematic review by Torgbenu et al 10 both recommend early intervention for the management of lymphedema. Current clinical practice often begins with a multimodal treatment strategy, which typically consists of self-management, elevation of the affected limb, exercise, compression, skin care, and manual lymphatic drainage (MLD).…”

MRI of Lymphedema

“… 7 Hallmark symptoms include discomfort, heaviness, numbness, skin thickening, disfigurement, and functional deficits, which can have a devastating impact to patients' physical, functional, and psychosocial well‐being 8,9 . There is a high financial cost as well; lymphedema‐related US hospitalizations from 2012 to 2017 resulted in greater than $1 billion of reimbursed costs, with most patients facing additional out‐of‐pocket costs 10–12 …”