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

Kimberly M. Brayton, Alan T. Hirsch, Patricia J. O'Brien, Andrea Cheville, Pinar Karaca-Mandic, Stanley G. Rockson

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38 Scopus citations

Abstract

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 (n51,065). 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%, p50.003), 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.

Original languageEnglish (US)
Article numbere114597
JournalPloS one
Volume9
Issue number12
DOIs
StatePublished - Dec 2014

Bibliographical note

Funding Information:
Kimberly Brayton, MD, is supported by Grant Number HS000028 from the NIH. The contents of this manuscript are solely the responsibility of the authors and do not necessarily represent the official views of the AHRQ. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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