Lymphedema prevalence and treatment benefits in cancer: impact of a therapeutic intervention on health outcomes and costs.

Gagan Deep,Kimberly M Brayton,Patricia J O′Brien,Alan T Hirsch,Pinar Karaca-Mandic,Stanley G Rockson,Andrea Cheville

doi:10.1371/journal.pone.0114597

Abstract

BackgroundLymphedema is a common complication of cancer therapeutics; its prevalence, treatment outcomes, and costs have been poorly defined. The objective of this study was to examine lymphedema prevalence among cancer survivors and to characterize changes in clinical outcomes and costs associated with a defined therapeutic intervention (use of a pneumatic compression devices [PCD]) in a representative, privately insured population.Methods and FindingsRetrospective analysis of de-identified health claims data from a large national insurer for calendar years 2007 through 2013. Patients were required to have 12 months of continuous insurance coverage prior to PCD receipt (baseline), as well as a 12-month follow-up period. Analyses were performed for individuals with cancer-related lymphedema (n = 1,065). Lymphedema prevalence was calculated: number of patients with a lymphedema claim in a calendar year divided by total number of enrollees. The impact of PCD use was evaluated by comparing rates of a pre-specified set of health outcomes and costs for the 12 months before and after, respectively, PCD receipt. Lymphedema prevalence among cancer survivors increased from 0.95% in 2007 to 1.24% in 2013. PCD use was associated with decreases in rates of hospitalizations (45% to 32%, p<0.0001), outpatient hospital visits (95% to 90%, p<0.0001), cellulitis diagnoses (28% to 22%, p = 0.003), and physical therapy use (50% to 41%, p<0.0001). The average baseline health care costs were high ($53,422) but decreased in the year after PCD acquisition (−$11,833, p<0.0001).ConclusionsLymphedema is a prevalent medical condition that is often a defining attribute of cancer survivorship. The problem is associated with high health care costs; Treatment (in this instance, use of PCD) is associated with significant decreases in adverse clinical outcomes and costs.

Highlights

Lymphedema is a vascular disorder that, in the Western world, arises most commonly as a consequence of cancer or its treatment
The objective of this study was to examine lymphedema prevalence among cancer survivors and to characterize changes in clinical outcomes and costs associated with a defined therapeutic intervention in a representative, privately insured population
The problem is associated with high health care costs; Treatment is associated with significant decreases in adverse clinical outcomes and costs

Summary

Introduction

Lymphedema is a vascular disorder that, in the Western world, arises most commonly as a consequence of cancer or its treatment. This is the most prevalent form of acquired or ‘‘secondary’’ lymphedema [1, 2]. While several single-center cohort studies have reported estimates of the prevalence of cancer-related lymphedema among breast cancer patients [3], the existing literature fails to fully define the population-based prevalence, health outcomes, and treatment costs of this disorder [4]. The objective of this study was to examine lymphedema prevalence among cancer survivors and to characterize changes in clinical outcomes and costs associated with a defined therapeutic intervention (use of a pneumatic compression devices [PCD]) in a representative, privately insured population. The average baseline health care costs were high ($53,422) but decreased in the year after PCD acquisition (2$11,833, p,0.0001)

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