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

14 Oct 2020

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.

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Most Read Articles
01 Dec 2020
Tetanus toxoid 5 Lf, diphtheria toxoid 2 Lf, pertussis toxoid 2.5 mcg, filamentous haemagglutinin 5 mcg, fimbriae types 2 and 3 5 mcg, pertactin 3 mcg
Dr. Hsu Li Yang, Dr. Tan Thuan Tong, Dr. Andrea Kwa, 08 Jan 2021
Antimicrobial resistance has become increasingly dire as the rapid emergence of drug resistance, especially gram-negative pathogens, has outpaced the development of new antibiotics. At a recent virtual symposium, Dr Hsu Li Yang, Vice Dean (Global Health) and Programme Leader (Infectious Diseases), NUS Saw Swee Hock School of Public Health, presented epidemiological data on multidrug-resistant (MDR) gram-negative bacteria (GNB) in Asia, while Dr Tan Thuan Tong, Head and Senior Consultant, Department of Infectious Diseases, Singapore General Hospital (SGH), focused on the role of ceftazidime-avibactam in MDR GNB infections. Dr Andrea Kwa, Assistant Director of Research, Department of Pharmacy, SGH, joined the panel in an interactive fireside chat, to discuss challenges, practical considerations, and solutions in MDR gram-negative infections. This Pfizer-sponsored symposium was chaired by Dr Ng Shin Yi, Head and Senior Consultant of Surgical Intensive Care, SGH.
Pearl Toh, 26 Nov 2020
Inhaled corticosteroid (ICS) should be the mainstay of long-term asthma management — such is the key message of the latest Singapore ACE* Clinical Guidance (ACG) for asthma, released in October 2020.
4 days ago
Daily intake of cow’s milk formula in early life helps prevent the development of cow’s milk allergy later on without competing with breastfeeding, a recent study has found.