Massachusetts Chapter of the American College of Surgeons

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Survival impact of re-resection for gallbladder cancer: a nationwide review
Susanna W.L. de Geus, Marianna V. Papageorge, Alison P. Woods, Sing Chau Ng, F. Thurston Drake, David McAneny, Jennifer F. Tseng, Teviah E. Sachs
Boston Medical Center, Boston, MA

Background: Lymph node transfer (LNT) and lymphovenous bypass (LVB) are two major surgical options for breast cancer-related lymphedema (BCRL). We performed a cost-effectiveness analysis comparing LNT and LVB for the treatment of BCRL.
Methods: Rates of infection, lymph leak, and failure for each surgery were obtained from literature review. Failure was defined as the inability to cease conservative therapy. Procedural costs were calculated from Medicare reimbursement rates. Cost of conservative management of postoperative surgical site infection, lymph leak, and continued decongestive physiotherapy after failed surgery were obtained from literature review. Average utility scores for each health state were obtained via visual analog scale, then converted to quality-adjusted life years (QALYs). A decision tree was constructed and incremental cost-effectiveness ratio was assessed at ,000/QALY. Deterministic and probabilistic sensitivity analyses were performed to evaluate the robustness of our findings.
Results: LNT was less costly ($22,464.71 vs $31,916.77) and more effective (31.83 QALY vs 29.24 QALY) than LVB. One-way (deterministic) sensitivity analysis demonstrated that LNT became cost-ineffective when its failure rate was >44.9%. LVB became more cost-effective than LNT when its failure rate was <21.4%. Probabilistic sensitivity analysis using Monte-Carlo simulation demonstrated that even with uncertainty present in the variables analyzed, the majority of simulations (97.5%) favored LNT as the more cost-effective strategy.
Conclusion: LNT is a dominant, cost-effective strategy compared to LVB for the treatment of BCRL.


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