Stout NL, Pfalzer LA, Springer B, Levy E, McGarvey CL, Danoff JV, Gerber LH, Soballe PW, et al.
Physical therapy. Date of publication 2012 Jan 1;volume 92(1):152-63.
1. Phys Ther. 2012 Jan;92(1):152-63. doi: 10.2522/ptj.20100167. Epub 2011 Sep 15.
Breast cancer-related lymphedema: comparing direct costs of a prospective
surveillance model and a traditional model of care.
Stout NL(1), Pfalzer LA, Springer B, Levy E, McGarvey CL, Danoff JV, Gerber LH,
Soballe PW.
Author information:
(1)National Naval Medical Center, Breast Care Center, Bethesda, MD 20814, USA.
Secondary prevention involves monitoring and screening to prevent negative
sequelae from chronic diseases such as cancer. Breast cancer treatment sequelae,
such as lymphedema, may occur early or late and often negatively affect function.
Secondary prevention through prospective physical therapy surveillance aids in
early identification and treatment of breast cancer-related lymphedema (BCRL).
Early intervention may reduce the need for intensive rehabilitation and may be
cost saving. This perspective article compares a prospective surveillance model
with a traditional model of impairment-based care and examines direct treatment
costs associated with each program. Intervention and supply costs were estimated
based on the Medicare 2009 physician fee schedule for 2 groups: (1) a prospective
surveillance model group (PSM group) and (2) a traditional model group (TM
group). The PSM group comprised all women with breast cancer who were receiving
interval prospective surveillance, assuming that one third would develop
early-stage BCRL. The prospective surveillance model includes the cost of
screening all women plus the cost of intervention for early-stage BCRL. The TM
group comprised women referred for BCRL treatment using a traditional model of
referral based on late-stage lymphedema. The traditional model cost includes the
direct cost of treating patients with advanced-stage lymphedema. The cost to
manage early-stage BCRL per patient per year using a prospective surveillance
model is $636.19. The cost to manage late-stage BCRL per patient per year using a
traditional model is $3,124.92. The prospective surveillance model is emerging as
the standard of care in breast cancer treatment and is a potential cost-saving
mechanism for BCRL treatment. Further analysis of indirect costs and utility is
necessary to assess cost-effectiveness. A shift in the paradigm of physical
therapy toward a prospective surveillance model is warranted.
DOI: 10.2522/ptj.20100167
PMCID: PMC3258414
PMID: 21921254 [Indexed for MEDLINE]
