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

Abstract

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). 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). One hundred female patients were included (mean age 58.5 years). Over 2 years, mean total costs were €16 234 (LVA) versus €14 293 (CDT); adjusted mean difference €78 (95% c.i. -€6044 to €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 €1716/QALY, with probabilities of cost-effectiveness of 0.60 and 0.71 at the €20 000 and €50 000 willingness-to-pay thresholds respectively. From a healthcare perspective, the ICER was €59 679/QALY, with probabilities of cost-effectiveness of 0.08 and 0.42 at the same thresholds respectively. 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. NCT02790021 (http://www.clinicaltrials.gov).