Lymphedema Prevalence and Treatment Benefits in Cancer: Impact of a Therapeutic Intervention on Health Outcomes and Costs

Abstract

BackgroundLymphedema is a common complication of cancer therapeutics; its prevalence, treatment outcomes, and costs have been poorly defined. The objective of this study was to examine lymphedema prevalence among cancer survivors and to characterize changes in clinical outcomes and costs associated with a defined therapeutic intervention (use of a pneumatic compression devices [PCD]) in a representative, privately insured population.Methods and FindingsRetrospective analysis of de-identified health claims data from a large national insurer for calendar years 2007 through 2013. Patients were required to have 12 months of continuous insurance coverage prior to PCD receipt (baseline), as well as a 12-month follow-up period. Analyses were performed for individuals with cancer-related lymphedema (n = 1,065). Lymphedema prevalence was calculated: number of patients with a lymphedema claim in a calendar year divided by total number of enrollees. The impact of PCD use was evaluated by comparing rates of a pre-specified set of health outcomes and costs for the 12 months before and after, respectively, PCD receipt. Lymphedema prevalence among cancer survivors increased from 0.95% in 2007 to 1.24% in 2013. PCD use was associated with decreases in rates of hospitalizations (45% to 32%, p<0.0001), outpatient hospital visits (95% to 90%, p<0.0001), cellulitis diagnoses (28% to 22%, p = 0.003), and physical therapy use (50% to 41%, p<0.0001). The average baseline health care costs were high ($53,422) but decreased in the year after PCD acquisition (−$11,833, p<0.0001).ConclusionsLymphedema is a prevalent medical condition that is often a defining attribute of cancer survivorship. The problem is associated with high health care costs; Treatment (in this instance, use of PCD) is associated with significant decreases in adverse clinical outcomes and costs.

The Cutaneous, Net Clinical, and Health Economic Benefits of Advanced Pneumatic Compression Devices in Patients With Lymphedema

“…17 Lymphedema therapeutic effectiveness has been demonstrated in patients with cancer, inasmuch as PCD use has been associated with significant decreases in rates of cellulitis diagnoses, outpatient services, and hospitalization. 5 Average baseline health care costs were high but decreased significantly in the year after receipt of a PCD. However, that study did not evaluate the relative benefit of the various types of PCDs currently available, nor did it evaluate the outcomes in individuals with non-cancer-related lymphedema.…”

“…[5][6][7] Lymphedema cannot be cured, but the establishment of the diagnosis and initiation of targeted therapies by dermatologists who frequently care for the patients with cellulitis can ameliorate the effect and progression of the disease. 8,9 Antibiotic therapies are useful to modify the risk of a first episode of cellulitis, but patients remain at heightened risk for recurrent cellulitis and/or systemic infection.…”

Intermittent pneumatic compression in patients with postmastectomy lymphedema

“…such compression provides much more access to treatment as compared to e.g. manual lymphatic drainage [23].…”

Daganatos betegekben kialakult másodlagos nyiroködéma ellátása

“…A palliatív ellátásba is fontos lenne beépíteni a nyiroködéma-kezelést, hiszen nagymérték-ben javíthatja a beteg életminőségét, és a komplex palliatív ellátásnak alapvető része [16,20,27]. Az időben elkezdett kezeléssel elkerülhetők a szövődmények, az egészségügyi kiadások csökkenthetők és a beteg számára jobb életminőség biztosítható [28].…”