Health Advances LLC, Weston, Mass.
Tactile Medical, Minneapolis, Minn.
J Vasc Surg. 2019 Feb;69(2):571-580. doi: 10.1016/j.jvs.2018.04.028. Epub 2018 Jun 15.
Phlebolymphedema (chronic venous insufficiency-related lymphedema) is a common and costly condition. Nevertheless, there is a dearth of evidence comparing phlebolymphedema therapeutic interventions. This study sought to examine the medical resource utilization and phlebolymphedema-related cost associated with Flexitouch (FLX; Tactile Medical, Minneapolis, Minn) advanced pneumatic compression devices (APCDs) relative to conservative therapy (CONS) alone, simple pneumatic compression devices (SPCDs), and other APCDs in a representative U.S. population of phlebolymphedema patients.
This was a longitudinal matched case-control analysis of deidentified private insurance claims. The study used administrative claims data from Blue Health Intelligence for the complete years 2012 through 2016. Patients were continuously enrolled for at least 18 months, diagnosed with phlebolymphedema, and received at least one claim for CONS either alone or in addition to pneumatic compression (SPCDs or APCDs). The main outcomes included direct phlebolymphedema- and sequelae-related medical resource utilization and costs.
After case matching, the study included 86 patients on CONS (87 on FLX), 34 on SPCDs (23 on FLX), and 69 on other APCDs (67 on FLX). Compared with CONS, FLX was associated with 69% lower per patient per year total phlebolymphedema- and sequelae-related costs net of any pneumatic compression device-related costs ($3839 vs $12,253; P = .001). This was driven by 59% fewer mean annual hospitalizations (0.13 vs 0.32; P < .001) corresponding to 82% lower inpatient costs and 55% lower outpatient hospital costs. FLX was also associated with 52% lower outpatient physical therapy and occupational therapy costs and 56% lower other outpatient-related costs. Compared with SPCDs, FLX was associated with 85% lower total costs ($1153 vs $7449; P = .008) driven by 93% lower inpatient costs ($297 vs $4215; P = .002), 84% lower outpatient hospital costs ($368 vs $2347; P = .020), and 85% lower other outpatient-related costs ($353 vs $2313; P = .023). Compared with APCDs, FLX was associated with 53% lower total costs ($3973 vs $8436; P = .032) because of lower outpatient costs and lower rates of cellulitis (22.4% vs 44.9% of patients; P = .02).
This analysis indicates significant benefits attributable to FLX compared with alternative compression therapies that can help reduce the notable economic burden of phlebolymphedema.
静脉淤滞性淋巴水肿（慢性静脉功能不全相关的淋巴水肿）是一种常见且昂贵的疾病。然而，目前缺乏比较静脉淤滞性淋巴水肿治疗干预措施的证据。本研究旨在考察 Flexitouch（FLX；Tactile Medical，明尼苏达州明尼阿波利斯）高级气动压缩设备（APCDs）相对于单独保守治疗（CONS）、简单气动压缩设备（SPCDs）和其他 APCDs 在具有代表性的美国静脉淤滞性淋巴水肿患者人群中的医疗资源利用情况和静脉淤滞性淋巴水肿相关成本。
这是一项使用匿名私人保险理赔数据进行的纵向匹配病例对照分析。该研究使用了 Blue Health Intelligence 提供的 2012 年至 2016 年完整年份的行政理赔数据。患者连续至少 18 个月接受治疗，被诊断患有静脉淤滞性淋巴水肿，并且至少有一次单独或与气动压缩（SPCDs 或 APCDs）联合使用 CONS 的理赔。主要结局包括直接与静脉淤滞性淋巴水肿及其后遗症相关的医疗资源利用和成本。
经过病例匹配后，本研究包括 86 名接受 CONS（87 名接受 FLX）、34 名接受 SPCDs（23 名接受 FLX）和 69 名接受其他 APCDs（67 名接受 FLX）的患者。与 CONS 相比，FLX 患者每年每人的总静脉淤滞性淋巴水肿及其后遗症相关费用降低了 69%，扣除任何气动压缩设备相关费用后（3839 美元比 12253 美元；P =.001）。这主要归因于每年平均住院次数减少了 59%（0.13 次比 0.32 次；P <.001），相应的住院费用降低了 82%，门诊医院费用降低了 55%。FLX 还与每年每人的门诊物理治疗和职业治疗费用降低 52%和其他门诊相关费用降低 56%相关。与 SPCDs 相比，FLX 患者的总费用降低了 85%（1153 美元比 7449 美元；P =.008），这主要是由于住院费用降低了 93%（297 美元比 4215 美元；P =.002）、门诊医院费用降低了 84%（368 美元比 2347 美元；P =.020）和其他门诊相关费用降低了 85%（353 美元比 2313 美元；P =.023）。与 APCDs 相比，FLX 患者的总费用降低了 53%（3973 美元比 8436 美元；P =.032），这是因为门诊费用降低了，且蜂窝织炎的发生率较低（22.4%的患者比 44.9%；P =.02）。
与替代压缩疗法相比，本分析表明 FLX 具有显著的获益，这有助于减轻静脉淤滞性淋巴水肿的显著经济负担。
