Massachusetts Chapter of the American College of Surgeons

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Cost-Effectiveness Analysis: Lymph Node Transfer versus Lymphovenous Bypass for Breast Cancer Related Lymphedema
Yurie Sekigami, MD1, Sydney Char, BS2, Cate Mullen, RN, MSN, AOCNS1, Kathryn Huber, MD, PhD1, Yu Cao, MD1, Rachel Buchsbaum, MD1, Roger Graham, MD1, Salvatore Nardello, DO3, Druv Singhal, MD4, Abhishek Chatterjee, MD MBA FACS1
1Tufts Medical Center, Boston, MA 2Tufts University School of Medicine, Boston, MA 3Tufts Medical Center Community Care, Boston, MA 4Beth Israel Deaconess 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 (,464.71 vs ,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<0.0001) and were not significantly different compared to scores for the non-intervention group. Conclusion: Firefly proved effective in tracking responses to supplemental training, which was associated with improved clinical laparoscopic skills and autonomy. Aggregated data analysis confirmed effectiveness of the programís educational intervention.


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