TY - JOUR
T1 - Incidence, treatment costs, and complications of lymphedema after breast cancer among women of working age
T2 - A 2-year follow-up study
AU - Shih, Ya Chen Tina
AU - Xu, Ying
AU - Cormier, Janice Nicole
AU - Giordano, Sharon
AU - Ridner, Sheila H.
AU - Buchholz, Thomas A
AU - Perkins, George H.
AU - Elting, Linda S.
N1 - Copyright:
Copyright 2012 Elsevier B.V., All rights reserved.
PY - 2009/4/20
Y1 - 2009/4/20
N2 - This study estimated the economic burden of breast cancer-related lymphedema (BCRL) among working-age women, the incidence of lymphedema, and associated risk factors. Methods We used claims data to study an incident cohort of breast cancer patients for the 2 years after the nitiation of cancer treatment. A logistic regression model was used to ascertain factors associated with lymphedema. We compared the medical costs and rate of infections likely associated with lymphedema between a woman with BCRL and a matched control. We performed nonparametric bootstrapping to compare the unadjusted cost differences and estimated the adjusted cost differences in regression analysis Results Approximately 10% of the 1,877 patients had claims indicating treatment of lymphedema Predictors included treatment with full axillary node dissection (odds ratio [OR] = 6.3, P < .001) and chemotherapy (OR = 1.6, P = .01). A geographic variation was observed; women who resided in the West were more likely to have lymphedema claims than those in the Northeast (OR = 2.05, P = .01). The matched cohort analysis demonstrated that the BCRL group had significantly higher medical costs ($14,877 to $23,167) and was twice as likely to have lymphangitis or cellulitis (OR = 2.02, P = .009). Outpatient care, especially mental health services, diagnostic imaging, and visits with moderate or high complexity, accounted for the majority of the difference Conclusion Although the use of claims data may underestimate the true incidence of lymphedema, women with BCRL had a greater risk of infections and incurred higher medical costs. The substantial costs documented here suggest that further efforts should be made to elucidate reduction and prevention strategies for BCRL.
AB - This study estimated the economic burden of breast cancer-related lymphedema (BCRL) among working-age women, the incidence of lymphedema, and associated risk factors. Methods We used claims data to study an incident cohort of breast cancer patients for the 2 years after the nitiation of cancer treatment. A logistic regression model was used to ascertain factors associated with lymphedema. We compared the medical costs and rate of infections likely associated with lymphedema between a woman with BCRL and a matched control. We performed nonparametric bootstrapping to compare the unadjusted cost differences and estimated the adjusted cost differences in regression analysis Results Approximately 10% of the 1,877 patients had claims indicating treatment of lymphedema Predictors included treatment with full axillary node dissection (odds ratio [OR] = 6.3, P < .001) and chemotherapy (OR = 1.6, P = .01). A geographic variation was observed; women who resided in the West were more likely to have lymphedema claims than those in the Northeast (OR = 2.05, P = .01). The matched cohort analysis demonstrated that the BCRL group had significantly higher medical costs ($14,877 to $23,167) and was twice as likely to have lymphangitis or cellulitis (OR = 2.02, P = .009). Outpatient care, especially mental health services, diagnostic imaging, and visits with moderate or high complexity, accounted for the majority of the difference Conclusion Although the use of claims data may underestimate the true incidence of lymphedema, women with BCRL had a greater risk of infections and incurred higher medical costs. The substantial costs documented here suggest that further efforts should be made to elucidate reduction and prevention strategies for BCRL.
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U2 - 10.1200/JCO.2008.18.3517
DO - 10.1200/JCO.2008.18.3517
M3 - Article
C2 - 19289624
AN - SCOPUS:65349141943
SN - 0732-183X
VL - 27
SP - 2007
EP - 2014
JO - Journal of Clinical Oncology
JF - Journal of Clinical Oncology
IS - 12
ER -