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

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 procedu...

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Main Authors: Joshua A. Bloom, MD, Melisa Granoff, BA, Tobias Karlsson, MD, Arin K. Greene, MD, MMSc, Håkan Brorson, MD, PhD, Abhishek Chatterjee, MD, MBA, Dhruv Singhal, MD
Format: Article
Language:English
Published: Wolters Kluwer 2022-11-01
Series:Plastic and Reconstructive Surgery, Global Open
Online Access:http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000004671
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author Joshua A. Bloom, MD
Melisa Granoff, BA
Tobias Karlsson, MD
Arin K. Greene, MD, MMSc
Håkan Brorson, MD, PhD
Abhishek Chatterjee, MD, MBA
Dhruv Singhal, MD
author_facet Joshua A. Bloom, MD
Melisa Granoff, BA
Tobias Karlsson, MD
Arin K. Greene, MD, MMSc
Håkan Brorson, MD, PhD
Abhishek Chatterjee, MD, MBA
Dhruv Singhal, MD
author_sort Joshua A. Bloom, MD
collection DOAJ
description 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.
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spelling doaj.art-530df55c90ed450db24800e36676b0b22022-12-22T03:43:40ZengWolters KluwerPlastic and Reconstructive Surgery, Global Open2169-75742022-11-011011e467110.1097/GOX.0000000000004671202211000-00040Power-assisted Liposuction for Lymphedema: A Cost-utility AnalysisJoshua A. Bloom, MD0Melisa Granoff, BA1Tobias Karlsson, MD2Arin K. Greene, MD, MMSc3Håkan Brorson, MD, PhD4Abhishek Chatterjee, MD, MBA5Dhruv Singhal, MD6From the * Department of Surgery, Tufts University Medical Center, Boston, Mass.† Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Boston, Mass.‡ Department of Clinical Sciences, Lund University, Plastic and Reconstructive Surgery, Skåne University Hospital, Malmö, Sweden§ Department of Plastic & Oral Surgery, Boston Children’s Hospital, Boston, Mass.‡ Department of Clinical Sciences, Lund University, Plastic and Reconstructive Surgery, Skåne University Hospital, Malmö, SwedenFrom the * Department of Surgery, Tufts University Medical Center, Boston, Mass.† Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Boston, Mass.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.http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000004671
spellingShingle Joshua A. Bloom, MD
Melisa Granoff, BA
Tobias Karlsson, MD
Arin K. Greene, MD, MMSc
Håkan Brorson, MD, PhD
Abhishek Chatterjee, MD, MBA
Dhruv Singhal, MD
Power-assisted Liposuction for Lymphedema: A Cost-utility Analysis
Plastic and Reconstructive Surgery, Global Open
title Power-assisted Liposuction for Lymphedema: A Cost-utility Analysis
title_full Power-assisted Liposuction for Lymphedema: A Cost-utility Analysis
title_fullStr Power-assisted Liposuction for Lymphedema: A Cost-utility Analysis
title_full_unstemmed Power-assisted Liposuction for Lymphedema: A Cost-utility Analysis
title_short Power-assisted Liposuction for Lymphedema: A Cost-utility Analysis
title_sort power assisted liposuction for lymphedema a cost utility analysis
url http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000004671
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