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

Area of Science:

• Medical Economics
• Surgical Oncology
• Lymphedema Research

Background:

• Lymphedema is a chronic, debilitating condition, significantly impacting breast cancer survivors.
• Debulking surgery offers improvements in extremity volume, quality of life, and reduced cellulitis incidence.
• Despite proven benefits, debulking surgery coverage remains inconsistent in the United States.

Purpose of the Study:

• To evaluate the cost-effectiveness of debulking surgery for upper extremity lymphedema.
• To compare clinical effectiveness and economic outcomes of debulking surgery versus conservative management.

Main Methods:

• Retrospective analysis of patients undergoing debulking surgery (December 2017-January 2020) with at least 12-month follow-up.
• Calculation of procedural costs using Medicare reimbursement data.
• Generation of a decision tree with quality-adjusted life years (QALYs) and incremental cost-utility ratios (ICURs).

Main Results:

• Debulking surgery demonstrated higher clinical effectiveness (27.05 QALYs) than conservative management (23.34 QALYs).
• A significant cost reduction of $74,487 was observed with debulking surgery.
• Sensitivity and rollback analyses favored debulking surgery, yielding a dominant negative ICUR of -20,115.07.

Conclusions:

• Debulking surgery is a clinically effective and cost-effective treatment for chronic upper extremity lymphedema.
• The findings support the wider adoption and consistent coverage of debulking surgery for lymphedema management.