Abstract

What are the economic burden and costs associated with the treatment of breast cancer-related lymphoedema? A systematic review

Tessa De Vrieze1,2 & Ines Nevelsteen3 & Sarah Thomis4 & An De Groef1 & Wiebren A. A. Tjalma5,6,7 & Nick Gebruers2,7 & Nele Devoogdt1,4. Supportive Care in Cancer 2019.

Objectives: To provide an overview of costs associated with the treatment of breast cancer-related lymphoedema(BCRL)and its possible sequelae, borne by patients or by society.

Data sources: According to the PRISMA guideline, a systematic literature search was carried out in four electronic databases: PubMed, Web of Science, Cochrane Clinical Trials and EMBASE. Searches were performed on October 1, 2018. Study selection Eligibility criteria: (1) expenses of adults (age > 18 years), (2) concerning patients with BCRL, (3) overview of (in)direct costs associated with BCRL, (4) expenses in which at least one type of conservative treatment modality for lymphoedema is included and/or costs for hospital admissions due to infections. Reviews and meta-analyses were excluded.

Data extraction: After assessing the risk of bias and level of evidence, quantitative data on (in)direct costs for BCRL treatment during a well-mentioned timeframe were extracted.

Data synthesis: Eight studies were included. Three studies reported on patient-born ecosts related to BCRL. Mean direct costs per year borne by patients ranged between USD$2306 and USD$2574. Indirect costs borne by patients ranged between USD$3325 and USD$5545 per year. Five studies estimated society-borne costs related to BCRL from claims data, billing prices and providers’ services during 12 to 24 months of follow-up. Mean direct treatment costs after 1 year of decongestive lymphatic therapy (DLT) ranged between €799 (= USD$1126.60) and USD$3165.

Conclusion: This systematic review revealed that BCRL imposes a substantial economic burden on patients and society. However, more standardized high-quality health economic analyses among this field are required. Recent economic analyses related to BCRL treatment in Europe, Asia, Africa and South America are lacking. Worldwide, further scrutiny of the economic impact of DLT for BCRL in clinical settings is needed.

Main findings

• This review reveals that BCRL imposes a substantial economic burden on patients and society. When solely direct costs are taken into account, in most cases, a significant proportion of costs is spent on physical therapy sessions and materials (e.g.compression garment), medication and hospital admissions in case of infections. During a 2-year post-operative period, patients with BCRL required significantly more hospitalizations and nearly seven times higher healthcare charge per patient compared to patients without BCRL (USD$141,388 vs. USD$21,141 per patient, respectively). If productivity losses were taken into account as well, the financial burden increased even more.
• Difficulties are being experienced regarding the comparability, transferability and generalizability of the present study results. Transferability is defined as the extent to which the results of a study hold true for a different population or setting. Since different continents, even different states/ countries within the same country/continent, are subjected to different health care insurance policies and reimbursement procedures, it is difficult to transfer the amount of healthcare costs derived in the USA or Australia to European countries and vice-versa