Economic evaluation of lymphaticovenous anastomosis versus conservative therapy for breast cancer-related lymphoedema: secondary outcome analysis of a randomized clinical trial

Background Lymphaticovenous anastomosis (LVA) is an increasingly applied microsurgical option for lymphoedema. The aim of this study was to evaluate the cost-effectiveness of LVA combined with complex decongestive therapy (CDT) versus CDT alone for breast cancer-related lymphoedema (BCRL).Methods A cost-effectiveness analysis was performed as a pre-specified secondary outcome of an RCT comparing LVA combined with CDT versus CDT alone. The primary outcome of the trial was health-related quality of life (HRQoL). A societal perspective with a 2-year time horizon was adopted. Quality-adjusted life-years (QALYs) were derived from the EuroQol five-dimension, five-level (EQ-5D-5L) questionnaire. Uncertainty was assessed using bootstrapping and sensitivity analysis. Data were collected from four Dutch hospitals. The primary outcome was the incremental cost-effectiveness ratio (ICER).Results One hundred female patients were included (mean age 58.5 years). Over 2 years, mean total costs were & euro;16 234 (LVA) versus & euro;14 293 (CDT); adjusted mean difference & euro;78 (95% c.i. -& euro;6044 to & euro;6200). Mean(s.e.) QALYs were 1.636(0.003) (LVA) versus 1.579(0.002) (CDT); adjusted mean difference 0.045 (95% c.i. -0.021 to 0.112). The ICER from a societal perspective was & euro;1716/QALY, with probabilities of cost-effectiveness of 0.60 and 0.71 at the & euro;20 000 and & euro;50 000 willingness-to-pay thresholds respectively. From a healthcare perspective, the ICER was & euro;59 679/QALY, with probabilities of cost-effectiveness of 0.08 and 0.42 at the same thresholds respectively.Conclusion LVA combined with CDT was more costly than CDT alone, but societal costs were limited during the 2-year follow-up interval. The LVA group acquired slightly more QALYs. From a societal perspective, LVA combined with CDT has the potential to be cost-effective, particularly when performed under local anaesthesia.Registration number NCT02790021 (http://www.clinicaltrials.gov).First RCT worldwide to evaluate both the clinical effectiveness and cost-effectiveness of lymphaticovenous anastomosis (LVA) combined with complex decongestive therapy (CDT) compared with CDT alone in patients with breast cancer-related lymphoedema (BCRL).Background Breast cancer can cause swelling in the arm. This is called lymphoedema. It can lead to pain and limit daily activities. Usual care includes compression sleeves, massage, and exercise. This care takes time and often continues for life. A new surgery, called lymphaticovenous anastomosis (LVA), may help reduce symptoms.Aim The authors studied whether adding LVA to usual care is worth the extra cost.Method The authors followed two groups of patients for 2 years. One group received usual care only and one group received LVA plus usual care. Quality of life and costs, such as healthcare use and time off work, were measured.Findings and conclusion Patients who had LVA reported a better quality of life. The surgery cost more money. When work and daily life were included, LVA may be worth the cost. When only healthcare costs were looked at, it was less likely to be worth the cost. In short, LVA may be a helpful extra treatment, but there is still some uncertainty.