title: Lymphedema prevalence and treatment benefits in cancer: impact of a therapeutic intervention on health outcomes and costs.
abstract: BACKGROUND
  Lymphedema is a common complication of cancer therapeutics; its prevalence, treatment outcomes, and costs have been poorly defined. The objective of this study was to examine lymphedema prevalence among cancer survivors and to characterize changes in clinical outcomes and costs associated with a defined therapeutic intervention (use of a pneumatic compression devices [PCD]) in a representative, privately insured population.
  
  
  RESULTS
  Retrospective analysis of de-identified health claims data from a large national insurer for calendar years 2007 through 2013. Patients were required to have 12 months of continuous insurance coverage prior to PCD receipt (baseline), as well as a 12-month follow-up period. Analyses were performed for individuals with cancer-related lymphedema (n = 1,065). Lymphedema prevalence was calculated: number of patients with a lymphedema claim in a calendar year divided by total number of enrollees. The impact of PCD use was evaluated by comparing rates of a pre-specified set of health outcomes and costs for the 12 months before and after, respectively, PCD receipt. Lymphedema prevalence among cancer survivors increased from 0.95% in 2007 to 1.24% in 2013. PCD use was associated with decreases in rates of hospitalizations (45% to 32%, p<0.0001), outpatient hospital visits (95% to 90%, p<0.0001), cellulitis diagnoses (28% to 22%, p = 0.003), and physical therapy use (50% to 41%, p<0.0001). The average baseline health care costs were high ($53,422) but decreased in the year after PCD acquisition (-$11,833, p<0.0001).
  
  
  CONCLUSIONS
  Lymphedema is a prevalent medical condition that is often a defining attribute of cancer survivorship. The problem is associated with high health care costs; Treatment (in this instance, use of PCD) is associated with significant decreases in adverse clinical outcomes and costs.
authors.affiliation: Stanford Center for Lymphatic and Venous Disorders, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, United States of America.
authors.forename: Kimberly M
authors.initials: KM
authors.lastname: Brayton
authors.affiliation: Cardiovascular Division, University of Minnesota Medical School, Minneapolis, MN, United States of America.
authors.forename: Alan T
authors.initials: AT
authors.lastname: Hirsch
authors.affiliation: Hematology/Oncology Division, University of Vermont, Burlington, VT, United States of America.
authors.forename: Patricia J
authors.initials: PJ
authors.lastname: O Brien
authors.affiliation: Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, United States of America.
authors.forename: Andrea
authors.initials: A
authors.lastname: Cheville
authors.affiliation: Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, United States of America.
authors.forename: Pinar
authors.initials: P
authors.lastname: Karaca-Mandic
authors.affiliation: Stanford Center for Lymphatic and Venous Disorders, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, United States of America.
authors.forename: Stanley G
authors.initials: SG
authors.lastname: Rockson
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007348:Insurance, Health; D048228:Intermittent Pneumatic Compression Devices; D008209:Lymphedema / Q000191:economics / Q000453:epidemiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000191:economics / Q000453:epidemiology / Q000473:pathology*; D015995:Prevalence; D016896:Treatment Outcome; D055815:Young Adult