American Association of Plastic Surgeons

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An Economic Cost-Minimization Analysis of Prophylactic Lymphovenous Microsurgery Among Breast Cancer Patients Receiving Mastectomy with Axillary Lymph Node Dissection
Lee Squitieri, MD, PhD, MS1, Petra W. Rasmussen, MPH2, Ketan M. Patel, MD1.
1University of Southern California, Los Angeles, CA, USA, 2University of California, Los Angeles, Los Angeles, CA, USA.

Purpose
Prophylatic lymphovenous bypass (LVB) has been shown to decrease the incidence of postoperative lymphedema among patients receiving mastectomy with axillary lymph node dissection (ALND). However, the economic impact of this intervention on healthcare costs has not been adequately studied. The purpose of this study was to compare the cost of prophylactic LVB compared to no surgical lymphedema intervention among patients receiving mastectomy with ALND.
Methods
A cost minimization analysis was performed using a societal perspective to assess two different patient scenarios: 1) mastectomy with ALND alone, 2) mastectomy with ALND and prophylactic LVB. A review of the existing literature was used to estimate the probability of postoperative lymphedema and costs were obtained from the 2018 Medicare Physician Fee Schedule (direct) and the 2017 U.S. Bureau of Labor Statistics (indirect). One-way sensitivity analyses were performed to evaluate threshold values for each model parameter.
Results
The cost of prophylactic LVB surgery among patients already receiving mastectomy and ALND was $1833.82 and the annual cost of lymphedema related care was estimated at $5,691.88 per patient. Prophylactic LVB resulted in an expected average lifetime cost of $5,172.11 for lymphedema care per patient compared to $13,942.26 for patients who receive mastectomy with ALND alone (average $8,770.15 lifetime cost saving per patient).
Conclusions
Prophylactic LVB surgery among patients already receiving mastectomy with ALND is the preferred strategy over mastectomy with ALND alone from a cost minimization perspective. On average, the lifetime costs associated with lymphedema are 62.9% lower if all patients receive prophylactic LVB surgery.


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