National Naval Medical Center, Breast Care Center, Bethesda, MD 20814, USA.
Phys Ther. 2012 Jan;92(1):152-63. doi: 10.2522/ptj.20100167. Epub 2011 Sep 15.
Secondary prevention involves monitoring and screening to prevent negative sequelae from chronic diseases such as cancer. Breast cancer treatment sequelae, such as lymphedema, may occur early or late and often negatively affect function. Secondary prevention through prospective physical therapy surveillance aids in early identification and treatment of breast cancer-related lymphedema (BCRL). Early intervention may reduce the need for intensive rehabilitation and may be cost saving. This perspective article compares a prospective surveillance model with a traditional model of impairment-based care and examines direct treatment costs associated with each program. Intervention and supply costs were estimated based on the Medicare 2009 physician fee schedule for 2 groups: (1) a prospective surveillance model group (PSM group) and (2) a traditional model group (TM group). The PSM group comprised all women with breast cancer who were receiving interval prospective surveillance, assuming that one third would develop early-stage BCRL. The prospective surveillance model includes the cost of screening all women plus the cost of intervention for early-stage BCRL. The TM group comprised women referred for BCRL treatment using a traditional model of referral based on late-stage lymphedema. The traditional model cost includes the direct cost of treating patients with advanced-stage lymphedema. The cost to manage early-stage BCRL per patient per year using a prospective surveillance model is $636.19. The cost to manage late-stage BCRL per patient per year using a traditional model is $3,124.92. The prospective surveillance model is emerging as the standard of care in breast cancer treatment and is a potential cost-saving mechanism for BCRL treatment. Further analysis of indirect costs and utility is necessary to assess cost-effectiveness. A shift in the paradigm of physical therapy toward a prospective surveillance model is warranted.
二级预防涉及监测和筛查，以预防癌症等慢性病的不良后果。乳腺癌治疗后遗症，如淋巴水肿，可能早发或晚发，且常对功能造成负面影响。通过前瞻性物理治疗监测进行二级预防有助于早期发现和治疗乳腺癌相关淋巴水肿（BCRL）。早期干预可能减少对强化康复的需求，并可能节省成本。本文从比较前瞻性监测模式与基于损伤的传统护理模式的角度出发，探讨了两种模式相关的直接治疗成本。干预和供应成本是基于 Medicare 2009 年医师费用表针对两组进行估算的：（1）前瞻性监测模式组（PSM 组）和（2）传统模式组（TM 组）。PSM 组包括所有接受间隔期前瞻性监测的乳腺癌女性，假设其中三分之一会发展为早期 BCRL。前瞻性监测模式包括对所有女性进行筛查的成本，以及对早期 BCRL 进行干预的成本。TM 组包括因晚期淋巴水肿采用传统转诊模式转诊来治疗 BCRL 的女性。传统模式的成本包括治疗晚期淋巴水肿患者的直接成本。使用前瞻性监测模式，每位患者每年管理早期 BCRL 的成本为 636.19 美元。使用传统模式，每位患者每年管理晚期 BCRL 的成本为 3124.92 美元。前瞻性监测模式正在成为乳腺癌治疗的标准护理模式，并且是 BCRL 治疗的一种潜在节省成本的机制。进一步分析间接成本和效用，以评估成本效益。有必要将物理治疗模式的观念转变为前瞻性监测模式。
