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

Bloom, Joshua A ; Granoff, Melisa ; Karlsson, Tobias LU orcid ; Greene, Arin K ; Brorson, Håkan LU orcid ; Chatterjee, Abhishek and Singhal, Dhruv (2022) In Plastic and reconstructive surgery. Global open 10(11).
Abstract

UNLABELLED: 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... (More)

UNLABELLED: 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.

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author
; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Plastic and reconstructive surgery. Global open
volume
10
issue
11
article number
E4671
publisher
Lippincott Williams & Wilkins
external identifiers
  • scopus:85149675443
  • pmid:36415620
ISSN
2169-7574
DOI
10.1097/GOX.0000000000004671
language
English
LU publication?
yes
id
7919fa8b-bb3a-4d0a-b1e4-86559aa784b0
alternative location
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9674478/pdf/gox-10-e4671.pdf
date added to LUP
2023-02-03 15:41:07
date last changed
2024-04-18 08:46:19
@article{7919fa8b-bb3a-4d0a-b1e4-86559aa784b0,
  abstract     = {{<p>UNLABELLED: 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.</p><p>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.</p><p>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.</p><p>CONCLUSION: Our study supports the use of debulking surgery for the treatment of chronic lymphedema of the upper extremity.</p>}},
  author       = {{Bloom, Joshua A and Granoff, Melisa and Karlsson, Tobias and Greene, Arin K and Brorson, Håkan and Chatterjee, Abhishek and Singhal, Dhruv}},
  issn         = {{2169-7574}},
  language     = {{eng}},
  number       = {{11}},
  publisher    = {{Lippincott Williams & Wilkins}},
  series       = {{Plastic and reconstructive surgery. Global open}},
  title        = {{Power-assisted Liposuction for Lymphedema : A Cost-utility Analysis}},
  url          = {{http://dx.doi.org/10.1097/GOX.0000000000004671}},
  doi          = {{10.1097/GOX.0000000000004671}},
  volume       = {{10}},
  year         = {{2022}},
}