Is Immediate Lymphatic Reconstruction Cost-effective?

Johnson, Anna Rose; Asban, Ammar; Granoff, Melisa D; Kang, Christine O.; Lee, Bernard T.; Chatterjee, Abhishek; Singhal, Dhruv

doi:10.1097/sla.0000000000003746

Cited by 47 publications

(52 citation statements)

References 35 publications

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“…Similar costing methods have been used for other plastic surgery procedures, including lymphatic surgery and breast reconstruction. [24][25][26] Societal or patient perspectives could also be considered; however, we have no reason to think these vantages would vary significantly. Patients who suffer mutilating hand injuries often require significant time-off of work, regardless of which reconstruction they undergo.…”

Section: Discussionmentioning

confidence: 99%

Bilaminate Synthetic Dermal Matrix versus Free Fascial Flaps: A Cost-Effectiveness Analysis for Full-Thickness Hand Reconstruction

Miller

Lin²,

Watt³

et al. 2021

J Reconstr Microsurg

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Background Full-thickness injuries to the hand require durable soft tissue coverage to preserve tendon gliding and hand motion. We aim to investigate the cost effectiveness of hand resurfacing comparing free fascial flap reconstruction versus bilaminate synthetic dermal matrices. Methods Cost effectiveness was modeled using decision tree analysis with the rollback method. Total active range of motion was modeled as the common outcome variable based on systematic literature review. Costing was performed from a payer perspective using national Medicare reimbursements. The willingness to pay threshold was determined by average worker's compensation for hand disability. Probabilistic sensitivity analysis was conducted for range of motion outcomes and the costs using 10,000 Monte Carlo simulations. Results The average cost of free fascial flap reconstruction was $14,201.24 compared with $13,674.20 for Integra, yielding an incremental cost difference of $527.04. Incremental range of motion improvement was 18.0 degrees with free fascial flaps, yielding an incremental cost effectiveness ratio of $29.30/degree of motion. Assuming willingness to pay thresholds of $557.00/degree of motion, free-fascial flaps were highly cost effective. On probabilistic sensitivity analysis, free fascial flaps were dominant in 25.5% of simulations and cost effective in 32.1% of simulations. Thus, microsurgical reconstruction was the economically sound technique in 57.5% of scenarios. Conclusion Free fascial flap reconstruction of complex hand wounds was marginally more expensive than synthetic dermal matrix and yielded incrementally better outcomes. Both dermal matrix and microsurgical techniques were cost effective in the base case and in sensitivity analysis. In choosing between dermal matrix and microsurgical reconstruction of complex hand wounds, neither technique has a clear economic advantage.

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Section: Discussionmentioning

confidence: 99%

Bilaminate Synthetic Dermal Matrix versus Free Fascial Flaps: A Cost-Effectiveness Analysis for Full-Thickness Hand Reconstruction

Miller

Lin²,

Watt³

et al. 2021

J Reconstr Microsurg

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“…Only one study performed a cost-utility analysis to evaluate and compare the cost and quality of life of patients undergoing ALND and ALND with RLNR, with and without LYMPHA, for patients with node-positive breast cancer 55 The addition of LYMPHA to ALND supposed an incremental cost of $2140.00, which was justified by a net clinical benefit of 1.35 quality-adjusted life years (QALYs) of ALND with LYMPHA (30.22 QALY) over ALND only (28.87 QALY). ALND and LYMPHA were more cost-effective with an incremental cost-utility ratios (ICUR) of $1587.73/QALY.…”

Section: Cost-efficacy Of Prophylactic Lymphovenous Anastomosismentioning

confidence: 99%

“…This article confirmed that the additional costs of primary prevention for LE can be justified from a cost-utility perspective for patients with both ALND and ALND with RLNR, especially considering that the complication rates of adding LYMPHA are negligible. 55…”

Section: Cost-efficacy Of Prophylactic Lymphovenous Anastomosismentioning

confidence: 99%

Microsurgical Strategies for Prophylaxis of Cancer-Related Extremity Lymphedema: A Comprehensive Review of the Literature

Rodríguez

Fuse

Yamamoto

2020

J Reconstr Microsurg

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Background Cancer-related lymphedema represents the first cause of noninfectious secondary extremity lymphedema. This entity is a progressive and debilitating disease with no curative treatment available. With the advent of lymphedema microsurgery, focus has turned into risk reduction and prevention of the disease progression. Methods Literature review was conducted to clarify current microsurgical approach to prophylaxis of cancer treatment-related extremity lymphedema. Results Prophylactic approach could be classified into primary and secondary prevention; microsurgical procedures were performed simultaneously with cancer ablation in primary prevention, and secondary prevention was performed secondarily after cancer treatment for selected high-risk subclinical cases. Indocyanine green lymphography was the most useful method for lymphedema screening after cancer treatment and to diagnose subclinical lymphedema. Several lymphovenous shunt operations were performed as prophylactic procedures, and classified into microsurgical lymphovenous implantation and supermicrosurgical lymphovenous intima-to-intima coaptation. Both showed clinically significant prophylactic effects. Conclusion This review provides a comprehensive overview of the literature regarding microsurgical interventions for the prevention of cancer-related extremity lymphedema. There are several methods for lymphedema prophylaxis and further studies are required to clarify indication of each method.

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“…It is estimated that 16%–49% of patients who undergo LND develop this disease. 1 – 5 Despite compliance with lifelong compression garments and manual lymphatic drainage, patients may still show disease progression.…”

Section: Introduction and Literature Reviewmentioning

confidence: 99%

“…17 The cost-effectiveness of ILR (after ALND ± radiation) was examined and found to be the more cost-effect treatment option (compared with ALND ± radiation without ILR) for node-positive breast cancer. 1 …”

Section: Introduction and Literature Reviewmentioning

confidence: 99%

Immediate Lymphatic Reconstruction: Technical Points and Literature Review

Coriddi

Mehrara

Skoracki

et al. 2021

Plastic and Reconstructive Surgery - Global Open

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Summary: Recent studies have provided evidence that lymphovenous bypass—microsurgical re-routing of divided lymphatics to an adjacent vein—performed at the time of lymph node dissection decreases the rate of lymphedema development. Immediate lymphatic reconstruction in this setting is technically demanding, and there is a paucity of literature describing the details of the surgical procedure. In this report, we review the literature supporting immediate lymphatic reconstruction and provide technical details to demystify the operation for surgeons who wish to provide this option to their patients.

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Is Immediate Lymphatic Reconstruction Cost-effective?

Abstract: Supplemental Digital Content is available in the text

Cited by 47 publications

References 35 publications

Bilaminate Synthetic Dermal Matrix versus Free Fascial Flaps: A Cost-Effectiveness Analysis for Full-Thickness Hand Reconstruction

Bilaminate Synthetic Dermal Matrix versus Free Fascial Flaps: A Cost-Effectiveness Analysis for Full-Thickness Hand Reconstruction

Microsurgical Strategies for Prophylaxis of Cancer-Related Extremity Lymphedema: A Comprehensive Review of the Literature

Immediate Lymphatic Reconstruction: Technical Points and Literature Review

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