Breast Cancer–Related Lymphedema: Comparing Direct Costs of a Prospective Surveillance Model and a Traditional Model of Care

Nicole L. Stout, Lucinda A. Pfalzer, Barbara Springer, Ellen Levy, Charles L. McGarvey, Jerome V. Danoff, Lynn H. Gerber, Peter W. Soballe


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.


  • Ms Stout, Dr Pfalzer, Dr Springer, Dr McGarvey, Dr Gerber, and Dr Soballe provided concept/idea/project design. Ms Stout, Dr Pfalzer, Dr Springer, Dr McGarvey, Dr Danoff, Dr Gerber, and Dr Soballe provided writing. Ms Stout, Dr Pfalzer, and Ms Levy provided data collection. Ms Stout and Dr Danoff provided data analysis. Ms Stout, Ms Levy, Dr McGarvey, and Dr Soballe provided project management. Dr McGarvey provided fund procurement and clerical support. Dr McGarvey and Dr Soballe provided participants and facilities/equipment. Ms Levy, Dr McGarvey, and Dr Danoff provided institutional liaisons. All authors provided consultation (including review of manuscript before submission).

  • A platform presentation of this work was given at the 2nd International Congress of Lymphology; September 19–23, 2011; Malmo, Sweden.

  • This work was supported by intramural funding through the US Department of Defense and the National Institutes of Health.

  • The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, the Department of Defense, or the US government.

  • Received May 13, 2010.
  • Accepted July 11, 2011.
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