Delayed autologous breast reconstruction with VLNT cost-effective in lymphoedema patients

The combination of vascularized lymph node transfer (VLNT) and delayed breast reconstruction is a cost-effective intervention option for patients with existing lymphoedema, a new study has shown.

Drawing from the Surveillance, Epidemiology, and End Results database, the researchers constructed a Markov model for the microsimulation of the cost-effectiveness of VLNT and breast reconstruction. An option was deemed attractive if the incremental cost-effectiveness ratio (ICER) per quality-adjusted life-year (QALY) gained was less than the willingness-to-pay threshold, which was set at USD 50,000.

The base case simulation showed that adding VLNT to delayed autologous breast reconstruction had an ICER of USD 1,158.23 per quality-adjusted life month (QALM) added for patients who already had existing lymphoedema. This translated to an ICER of USD 13,898.76 per QALY gained, which was within the acceptable payment threshold.

The researchers also looked at the cost-effectiveness of the routine combination of VLNT with autologous breast reconstruction for the prevention of lymphoedema. They found that this approach could be a cost-effective prophylaxis measure if patients were undergoing axillary lymph node dissection and if VLNT had a 66-percent efficacy of preventing breast cancer-related lymphoedema.

However, even when VLNT was 100-percent effective, using it as a prophylaxis was hard to justify when patients were undergoing sentinel lymph node biopsy alone.

The findings of the current study “could have implications for the application of the evolving technique of VLNT in the treatment of different subpopulations of breast cancer patients and future clinical research,” the researchers said.