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

Introduction Lymphaticovenous anastomosis (LVA) is an increasingly applied microsurgical option for lymphoedema. This study evaluated the cost-effectiveness of LVA combined with complex decongestive therapy (CDT) versus CDT alone for breast cancer-related lymphoedema (BCRL). Method A cost-effectiveness analysis was performed as a pre-specified secondary outcome of a randomized controlled trial comparing LVA combined with CDT to 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-5D-5L. 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 two years, mean total costs were €16,234 (LVA) vs. €14,293 (CDT); adjusted mean difference €78 (95% CI, -€6,044; €6,200). Mean QALYs were 1.636 (SE 0.003) (LVA) vs. 1.579 (SE 0.002) (CDT); adjusted mean difference 0.045 (95%CI, -0.021; 0.112). The ICER from a societal perspective was €1,716/QALY, with a probability of cost-effectiveness of 0.60 at €20,000 and 0.71 at €50,000 willingness-to-pay thresholds. From a healthcare perspective, the ICER was €59,679/QALY, with a 0.08 and 0.42 probability of cost-effectiveness at the same thresholds, respectively. Conclusion LVA with CDT was more costly than CDT alone, but societal costs were limited during the 2-year follow-up period. 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. Trial registration: Clinicaltrials.gov, NCT02790021 (https://clinicaltrials.gov/study/NCT02790021).