Cost-effectiveness analysis of lymphaticovenous anastomosis in reducing cellulitis recurrence in 150 lymphoedema cases followed-up over 24 months.

Abstract

Lymphoedema is a chronic condition that imposes ongoing costs on the patient and National Health Service (NHS). This study aimed to estimate the cost-effectiveness of lymphaticovenous anastomosis (LVA) in reducing cellulitis recurrence in 150 patients with lymphoedema who were followed-up for over 24 months. Data were prospectively captured pre- and post-LVA surgery in 150 patients with unilateral lower or upper limb lymphoedema in a centre in the UK. Data collection included cellulitis resource utilisation with costs identified from the British National Formulary, Personal Social Services Research Unit, and a quality-of-life questionnaire (EQ-5D-5L). The mean overall costs for cellulitis and hospital admissions reduced by £1389.85, which was statistically significant (p < 0.001). Mean per patient reduction of costs across the 24-months was estimated at -£1405.62 (CI: -£1878.09, -£933.16). When the cost of LVA (£4551) was included, the reductions were offset to £3145.37 (CI: £2672.90, £3617.84). The mean EQ-5D-5L utility score (n = 143) increased from 0.743 (SD 0.168) to 0.800 (SD 0.196), being statistically significant (p = <0.001). The incremental cost-effectiveness ratio (ICER) through costs and EQ-5D-5L changes was £54231, indicating that LVA costs more, but is more effective. LVA benefits patients for more than the 24-months captured, thus costs would be reduced based on the patients' life expectancy. This cost-effectiveness analysis provided an in-depth examination of a large cohort of LVA patients who were followed up for 24 months, highlighting decreased cellulitis recurrence.