Cost-Effectiveness Analysis: Lymph Node Transfer vs Lymphovenous Bypass for Breast Cancer-Related Lymphedema

Sekigami, Yurie; Char, Sydney; Mullen, Cate; Huber, Kathryn E.; Cao, Yu; Buchsbaum, Rachel J.; Graham, Roger A.; Nardello, Salvatore; Singhal, Dhruv; Chatterjee, Abhishek

doi:10.1016/j.jamcollsurg.2021.02.013

Cited by 12 publications

(7 citation statements)

References 28 publications

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“…Despite this, the third-party payer perspective is well defined and accepted within the realm of cost-utility literature, most notably the CHEERS criteria checklist. 33,39,[41][42][43][44][45][46][47]…”

Section: Discussionmentioning

confidence: 99%

A Cost-Utility Analysis of the Use of Closed-Incision Negative Pressure System in Vascular Surgery Groin Incisions

Bloom

Tian

Homsy

et al. 2022

The American Surgeon™

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Objective Closed-incision negative pressure therapy (CINPT) with the Prevena system has been used and clinically evaluated in high-risk groin incisions to reduce the risk of postoperative complications. We performed a cost-effectiveness analysis evaluating CINPT in femoral-popliteal bypass with prosthetic graft. Methods A literature review looking at prospective randomized trials determined the probabilities and outcomes for femoral-popliteal bypass with and without CINPT. Reported utility scores were used to estimate the quality adjusted life years (QALYs) associated with a successful procedure and postoperative complications. Medicare current procedure terminology and diagnosis-related group codes were used to assess the costs for a successful surgery and associated complications. A decision analysis tree was constructed with rollback analysis to highlight the more cost-effective strategy. An incremental cost-effectiveness ratio (ICER) analysis was performed with a willingness to pay at $50,000. Deterministic and probabilistic sensitivity analyses were performed to validate the robustness of the results, and to accommodate for the uncertainty in the literature. Results Femoral-popliteal bypass with CINPT is less costly ($40,138 vs $41,774) and more effective (6.14 vs 6.13) compared to without CINPT. This resulted in a negative ICER of −234,764.03, which favored CINPT, indicating a dominant strategy. In one-way sensitivity analysis, surgery without CINPT was more cost-effective if the probability of successful surgery falls below 84.9% or if the cost of CINPT exceeds $3139. Monte Carlo analysis showed a confidence of 99.07% that CINPT is more cost-effective. Conclusions Despite the added device cost of CINPT, it is cost-effective in vascular surgical operations using groin incisions.

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Section: Discussionmentioning

confidence: 99%

A Cost-Utility Analysis of the Use of Closed-Incision Negative Pressure System in Vascular Surgery Groin Incisions

Bloom

Tian

Homsy

et al. 2022

The American Surgeon™

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“…Published national analyses demonstrating the cost-effectiveness of both preventive and therapeutic physiologic procedures use Medicare and/or Medicaid fee schedules in their cost forecasting, as these rates were historically the only publicly available rates before the Hospital Price Transparency Rule. 10,44,45 Only one of these studies discloses the CPT codes used in their modeling. 10 Although we demonstrate an overall correlation of commercial and Medicare rates for physiologic CPT codes, the magnitude of this correlation varied depending on the code.…”

Section: Discussionmentioning

confidence: 99%

Commercial Insurance Rates and Coding for Lymphedema Procedures: The Current State of Confusion and Need for Consensus

Rochlin

Sheckter

Brazio

et al. 2023

Plastic &Amp; Reconstructive Surgery

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Background: Surgical treatment of lymphedema has outpaced coding paradigms. In the setting of ambiguity regarding coding for physiologic procedures [lymphovenous bypass (LVB) and vascularized lymph node transplant (VLNT)], we hypothesized that there would be variation in commercial reimbursement based on coding pattern. Methods: The authors performed a cross-sectional analysis of 2021 nationwide hospital pricing data for 21 CPT codes encompassing excisional (direct excision, liposuction), physiologic (LVB, VLNT), and ancillary (lymphangiography) procedures. Within-hospital ratios (WHRs) and across-hospital ratios (AHRs) for adjusted commercial rates per CPT code quantified price variation. Mixed effects linear regression modeled associations of commercial rate with public payer (Medicare and Medicaid), self-pay, and chargemaster rates. Results: A total of 270,254 commercial rates, including 95,774 rates for physiologic procedures, were extracted from 2863 hospitals. Lymphangiography codes varied most in commercial price (WHR, 1.76 to 3.89; AHR, 8.12 to 44.38). For physiologic codes, WHRs ranged from 1.01 (VLNT; free omental flap) to 3.03 (LVB; unlisted lymphatic procedure), and AHRs ranged from 5.23 (LVB; lymphatic channel incision) to 10.36 (LVB; unlisted lymphatic procedure). Median adjusted commercial rates for excisional procedures ($3635.84) were higher than for physiologic procedures ($2560.40; P < 0.001). Commercial rate positively correlated with Medicare rate for all physiologic codes combined, although regression coefficients varied by code. Conclusions: Commercial payer–negotiated rates for physiologic procedures were highly variable both within and across hospitals, reflective of variation in CPT codes. Physiologic procedures may be undervalued relative to excisional procedures. Consistent coding nomenclature should be developed for physiologic and ancillary procedures.

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“…We agree with the authors that previous cost-effectiveness studies strongly argue in favor of appropriate reimbursement for lymphatic procedures. 3–5 Sekigami et al 5 and Johnson et al 3 further strengthen this argument, recognizing variation in payment for lymphatic procedures through sensitivity analyses, and demonstrating that the value of physiologic procedures for lymphedema are cost-effective even in the setting of higher surgical payments. Continued undervaluation and inadequate reimbursement introduce the risk of deterring future surgeons from entering this burgeoning field, thereby resulting in recession of the field before it can grow.…”

mentioning

confidence: 96%

Discussion: Commercial Insurance Rates and Coding for Lymphedema Procedures: The Current State of Confusion and Need for Consensus

Friedman,

Lee,

Chatterjee

et al. 2023

Plastic &Amp; Reconstructive Surgery

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D ialogue pertaining to the CPT coding system for lymphatic procedures is long overdue. We therefore commend the authors for their recent publication 1 and for bringing this matter to light, as there continues to be a lack of consensus around CPT coding of lymphatic operations. Recently, a greater clinical consensus has been developing in terms of procedural algorithms for the surgical management of lymphedema. History has shown that the standardization of best practices as demonstrated by the establishment of Centers of Excellence, along with consensus on CPT coding, will promote the passage of medical policy. Although we agree with the authors that CPT coding is an important step toward policy change, we also strongly believe that concurrent efforts toward standardizing the delivery of care are of equal importance. For example, recent progress toward clinical consensus has driven medical policy change to provide coverage for the surgical treatment for lymphedema in Massachusetts. 2 In the process of standardizing the CPT coding framework for lymphatic operations, it is also critical that consistent nomenclature be developed for these procedures. We have previously observed that how we document our procedures can significantly impact whether or not they are reimbursed. 2 We proposed a standardized framework of referring to lymphatic operations as "lymphatic reconstruction." Lymphatic operations performed for prevention would be termed "immediate lymphatic reconstruction"

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Cost-Effectiveness Analysis: Lymph Node Transfer vs Lymphovenous Bypass for Breast Cancer-Related Lymphedema

Cited by 12 publications

References 28 publications

A Cost-Utility Analysis of the Use of Closed-Incision Negative Pressure System in Vascular Surgery Groin Incisions

A Cost-Utility Analysis of the Use of Closed-Incision Negative Pressure System in Vascular Surgery Groin Incisions

Commercial Insurance Rates and Coding for Lymphedema Procedures: The Current State of Confusion and Need for Consensus

Discussion: Commercial Insurance Rates and Coding for Lymphedema Procedures: The Current State of Confusion and Need for Consensus

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