Humphreys I, Thomas M, Pike C, Morgan K, Jessop Z, Bragg T, Ghattaura A
School of Health and Social Care, Swansea University, Swansea, United Kingdom.
Lymphoedema Wales Clinical Network, Swansea Bay University Health Board, Port Talbot, United Kingdom.
J Plast Reconstr Aesthet Surg. 2025 Jul;106:42-49. doi: 10.1016/j.bjps.2025.04.032. Epub 2025 Apr 25.
Lymphoedema is a chronic condition that imposes ongoing costs on the patient and National Health Service (NHS). This study aimed to estimate the cost-effectiveness of lymphaticovenous anastomosis (LVA) in reducing cellulitis recurrence in 150 patients with lymphoedema who were followed-up for over 24 months.
Data were prospectively captured pre- and post-LVA surgery in 150 patients with unilateral lower or upper limb lymphoedema in a centre in the UK. Data collection included cellulitis resource utilisation with costs identified from the British National Formulary, Personal Social Services Research Unit, and a quality-of-life questionnaire (EQ-5D-5L).
The mean overall costs for cellulitis and hospital admissions reduced by £1389.85, which was statistically significant (p < 0.001). Mean per patient reduction of costs across the 24-months was estimated at -£1405.62 (CI: -£1878.09, -£933.16). When the cost of LVA (£4551) was included, the reductions were offset to £3145.37 (CI: £2672.90, £3617.84). The mean EQ-5D-5L utility score (n = 143) increased from 0.743 (SD 0.168) to 0.800 (SD 0.196), being statistically significant (p = <0.001). The incremental cost-effectiveness ratio (ICER) through costs and EQ-5D-5L changes was £54231, indicating that LVA costs more, but is more effective. LVA benefits patients for more than the 24-months captured, thus costs would be reduced based on the patients' life expectancy.
This cost-effectiveness analysis provided an in-depth examination of a large cohort of LVA patients who were followed up for 24 months, highlighting decreased cellulitis recurrence.
淋巴水肿是一种慢性病，给患者和国民医疗服务体系（NHS）带来持续的费用负担。本研究旨在评估在150例接受了超过24个月随访的淋巴水肿患者中，淋巴管静脉吻合术（LVA）在降低蜂窝织炎复发方面的成本效益。
在英国一个中心，前瞻性收集了150例单侧下肢或上肢淋巴水肿患者LVA手术前后的数据。数据收集包括蜂窝织炎资源利用情况，成本从《英国国家处方集》、个人社会服务研究单位以及一份生活质量问卷（EQ-5D-5L）中确定。
蜂窝织炎和住院的平均总成本降低了1389.85英镑，具有统计学意义（p < 0.001）。估计24个月内每位患者的平均成本降低为-1405.62英镑（CI：-1878.09，-933.16）。当纳入LVA的成本（4551英镑）时，成本降低额被抵消至3145.37英镑（CI：2672.90，3617.84）。平均EQ-5D-5L效用评分（n = 143）从0.743（标准差0.168）提高到0.800（标准差0.196），具有统计学意义（p = <0.001）。通过成本和EQ-5D-5L变化得出的增量成本效益比（ICER）为54231英镑，表明LVA成本更高，但更有效。LVA对患者的益处超过了所记录的24个月，因此基于患者的预期寿命，成本将会降低。
这项成本效益分析对一大群接受了24个月随访期的LVA患者进行了深入研究，突出了蜂窝织炎复发率的降低。
