Brayton KM, Hirsch AT, O Brien PJ, Cheville A, Karaca-Mandic P, Rockson SG, et al.
PloS one. Date of publication 2014 Dec 3;volume 9(12):e114597.
1. PLoS One. 2014 Dec 3;9(12):e114597. doi: 10.1371/journal.pone.0114597.
eCollection 2014.
Lymphedema prevalence and treatment benefits in cancer: impact of a therapeutic
intervention on health outcomes and costs.
Brayton KM(1), Hirsch AT(2), O Brien PJ(3), Cheville A(4), Karaca-Mandic P(5),
Rockson SG(1).
Author information:
(1)Stanford Center for Lymphatic and Venous Disorders, Division of Cardiovascular
Medicine, Stanford University School of Medicine, Stanford, California, United
States of America.
(2)Cardiovascular Division, University of Minnesota Medical School, Minneapolis,
MN, United States of America.
(3)Hematology/Oncology Division, University of Vermont, Burlington, VT, United
States of America.
(4)Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, United
States of America.
(5)Division of Health Policy and Management, School of Public Health, University
of Minnesota, Minneapolis, MN, United States of America.
BACKGROUND: Lymphedema 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 FINDINGS: Retrospective 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).
CONCLUSIONS: Lymphedema 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.
DOI: 10.1371/journal.pone.0114597
PMCID: PMC4255037
PMID: 25470383 [Indexed for MEDLINE]
