Power-assisted Liposuction for Lymphedema: A Cost-utility Analysis

Abstract

Background: Lymphedema is a chronic, debilitating disease that has been described as the largest breast cancer survivorship burden. Debulking surgery has been shown to improve extremity volume, improve patient quality of life, and decrease the incidence of cellulitis in the literature. This procedure is routinely covered in numerous other developed countries, yet it is still inconsistently covered in the United States. Methods: Extremity volumes from all patients who underwent debulking surgery of the upper extremity at two institutions between December 2017 and January 2020 with at least 12 months follow-up were included. Procedural costs were calculated using Medicare reimbursement data. Average utility scores were obtained for each health state using a visual analog scale, then converted to quality-adjusted life years. A decision tree was generated, and incremental cost-utility ratios were calculated. Sensitivity analyses were performed to evaluate our findings. Results: Debulking surgery is associated with a higher clinical effectiveness (quality-adjusted life year) of 27.05 compared to conservative management (23.34), with a relative cost reduction of $74,487. Rollback analysis favored debulking surgery as the cost-effective option compared to conservative management. The resulting negative incremental cost-utility ratio of −20,115.07 favored debulking surgery and indicated a dominant strategy. Conclusion: Our study supports the use of debulking surgery for the treatment of chronic lymphedema of the upper extremity.

United States insurance coverage of immediate lymphatic reconstruction

“…30 Bloom et al estimated a lifetime out-of-pocket cost of $83,240 for compression garments and physical therapy as conservative lymphedema management. 31 A handful of studies have investigated the economic utility of ILR specifically. Squitieri et al found that ILR is economically preferred over mastectomy and ALND alone from a cost minimization perspective, and results in an average of $7646.65 (45.2%) cost saving per patient over the course of their lifetime.…”

“…It has been shown that among breast cancer patients, those who develop BCRL incur significantly higher costs associated with their care ($86 707 vs. $64,554, p = 0.0002), including mental health services, diagnostic imaging, and complex outpatient visits 30 . Bloom et al estimated a lifetime out‐of‐pocket cost of $83,240 for compression garments and physical therapy as conservative lymphedema management 31 . A handful of studies have investigated the economic utility of ILR specifically.…”

A Cost-Effectiveness Analysis of Wittmann Patch-Assisted Abdominal Closure Compared to Planned Ventral Hernia in Management of the Open Abdomen

“…The model adopted the perspective of the third-party payer, which has been well described in the literature. [16][17][18][19][20] We used publicly available cost data from 2023 Medicare current procedure terminology (CPT) codes and diagnosis-related group (DRG) codes. Direct surgical costs of both procedures, as well as associated costs of each health state, were reported in US$2023 (Table 1).…”

We Are Not Speaking the Same Language

“…24 Although compression therapy remains widely used, surgical interventions offer cost-effective options and hope for improved outcomes and quality of life. [24][25][26][27] Despite the emergence of effective lymphatic reconstruction techniques more than 15 years ago, many patients are never offered treatment due to inaccessibility of care. 28 While public and insurance policy attempt to maintain pace with standard surgical practices, the absence of specific Current Procedural Terminology (CPT) codes to describe lymphatic reconstruction may pose a barrier to insurance authorization and ultimately surgical treatment.…”

“…Combining physiologic microsurgical procedures (LVB or VLNT) with liposuction has consistently enhanced outcomes, reducing the need for lifelong compression garment use 24 . Although compression therapy remains widely used, surgical interventions offer cost-effective options and hope for improved outcomes and quality of life 24–27 …”