Is Immediate Lymphatic Reconstruction Cost-Effective for Breast Cancer Lymphedema?

Lymphedema related to breast cancer is a common and debilitating complication following axillary lymph node dissection (ALND) and regional nodal irradiation. It leads to substantial long-term morbidity and economic burden. Effective prevention strategies are essential to improving quality of life and reducing healthcare costs.

A model-based cost-effectiveness analysis was conducted from a payer perspective using a decision tree framework. Literature-based inputs informed the model, and patients were stratified into five oncologic treatment cohorts involving various combinations of surgery, chemotherapy, and radiation. The base case was a 45-year-old undergoing ALND for stage III breast cancer. Three prevention strategies were evaluated: the immediate lymphatic reconstruction (ILR), prospective surveillance, and no specific intervention. Outcomes included total costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs). Sensitivity analyses tested model robustness.

Both prospective surveillance and ILR were cost-effective compared to no intervention. No intervention yielded the lowest cost ($10,774) and lowest effectiveness (17.94 QALYs). Prospective surveillance improved outcomes at minimal additional cost ($11,415; 19.85 QALYs), with an ICER of $344/QALY. ILR provided the greatest health benefit and incurred the highest cost ($15,426; 22.35 QALYs), but its ICER ($1,607/QALY) remained well below the willingness-to-pay threshold. Sensitivity analyses confirmed robust findings across varied inputs.

ILR and prospective surveillance are cost-effective strategies for preventing lymphedema following ALND. ILR offers the greatest health benefit and supports broader integration of preventive microsurgical approaches into multidisciplinary breast cancer care.