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Breast cancer-related lymphedema and its treatment: how big is the financial impact?

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Abstract

Purpose

Decongestive lymphatic treatment (DLT) is still the gold standard for treatment of breast cancer-related lymphedema (BCRL). With up to 17% of the patients treated for breast cancer developing BCRL, this morbidity imposes a tremendous financial burden for patients and society. Knowledge about this economic burden related to BCRL and its conservative treatment in a European setting is lacking. The aim of this prospective, longitudinal cohort study was to estimate the direct healthcare costs related to BCRL and its treatment in a European setting.

Methods

Patients with BCRL were treated with DLT consisting of an intensive treatment phase of 3 weeks, followed by a maintenance treatment phase of 6 months. Additionally, the follow-up period comprised 6 months. During these 3 weeks and 12 months, all direct costs associated with the treatment of BCRL and its sequelae were documented through billing prices and a self-developed questionnaire which was administered after the intensive treatment phase, and subsequently 3-monthly during the entire period.

Results

A total of 194 patients were enrolled in this study. Of these, 17% (n = 32) showed lymphedema stage I, 56% (n = 109) had lymphedema stage IIa, and 27% (n = 53) had lymphedema stage IIb. Total direct healthcare costs per patient were €2248.93 on average during the entire period of 3 weeks of intensive treatments and 12 months of maintenance decongestive therapy. Within these mean direct costs, €1803.35 (80%) was accounted for statutory health insurances, and €445.58 (20%) was out-of-pocket expenses for patients.

Conclusion

This study is one of the first standardized high-quality health economic analyses of BRCL treatment in Europe. The present study indicates that the price tag of BCRL treatment in Belgium is high not only for the health insurance but also for the patients

Clinical trial registration number

The study makes part of a double-blind, multi-center, randomized controlled trial (EFforT-BCRL trial), which is registered in clinicaltrials.gov (NCT02609724). CME reference S58689, EudraCT Number 2015-004822-33.

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Data availability

The lead author affirms that this manuscript is an honest, accurate, and transparent account of the study being reported. Relevant patient level data, a full dataset, and statistical analyses are available from the corresponding author (tessa.devrieze@kuleuven.be) upon reasonable request.

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Acknowledgments

The authors are very grateful to the hospitals collaborating in this study. The authors also extend very grateful thanks to the study participants.

Funding

This study is financed by the Agency for Innovation by Science and Technology, applied Biomedical Research (IWT 150178). In order to arrange such financing, a separate collaboration agreement has been signed by the KU Leuven and the beneficiaries.

Author information

Authors and Affiliations

  1. Department of Rehabilitation Sciences, KU Leuven - University of Leuven, O&N IV Herestraat 49, box 1510, 3000, Leuven, Belgium

    Tessa De Vrieze, An De Groef, Lore Dams, Vincent Haenen & Nele Devoogdt

  2. Department of Rehabilitation Sciences and Physiotherapy, MOVANT, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Antwerp, Belgium

    Tessa De Vrieze, Nick Gebruers, An De Groef, Lore Dams & Vincent Haenen

  3. Multidisciplinary Oedema Clinic, University of Antwerp and Antwerp University Hospital, Antwerp, Belgium

    Nick Gebruers & Wiebren A. A. Tjalma

  4. Multidisciplinary Breast Centre, UZ Leuven – University Hospitals Leuven, Leuven, Belgium

    Ines Nevelsteen

  5. Multidisciplinary Breast Clinic, Antwerp University Hospital, Antwerp, Belgium

    Wiebren A. A. Tjalma

  6. Center for lymphedema, UZ Leuven - University Hospitals Leuven, Leuven, Belgium

    Sarah Thomis & Nele Devoogdt

Authors
  1. Tessa De Vrieze
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  2. Nick Gebruers
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Contributions

All the authors critically revised the manuscript for important intellectual content and approved the final manuscript.

Corresponding author

Correspondence to Tessa De Vrieze.

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Support statement: ADG is a post-doctoral research fellow of the FWO-Flanders.

Appendix

Appendix

Table 4. Information regarding fees and reimbursement rates for physical therapy sessions in Belgium
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Table 5. Bandaging materials used per patient during the intensive treatment phase
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De Vrieze, T., Gebruers, N., Nevelsteen, I. et al. Breast cancer-related lymphedema and its treatment: how big is the financial impact?. Support Care Cancer 29, 3801–3813 (2021). https://doi.org/10.1007/s00520-020-05890-3

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