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

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 (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.

Conflict of interest statement

Competing Interests: Alan T. Hirsch, MD, serves as Chief Medical Officer of Tactile Medical, a company which manufactures a product used to treat lymphedema. This relationship has been reviewed and managed by the University of Minnesota in accordance with its Conflict of Interest policies. This relationship does not alter the authors' adherence to PLOS ONE policies on sharing data and materials. Pinar Karaca-Mandic, PhD, provides health economics consulting services to Tactile Medical, a company which manufactures a product used to treat lymphedema. This relationship is reported to the University of Minnesota. This relationship does not alter the authors' adherence to PLOS ONE policies on sharing data and materials.

Figures

Figure 1. Flow diagram depicting the selection strategy for patients included in this analysis.

Figure 2. Schematic of the study design protocol.