Impact of Breast Cancer-Related Lymphedema on Cancer Care Costs: Longitudinal and Age-Based Analyses.

[PURPOSE] How breast cancer-related lymphedema (BCRL) costs evolve over time, especially for younger patients, is poorly understood. We sought to characterize BCRL-associated costs by age and treatment phase.

[METHODS] Using Massachusetts All-Payer Claims data, we compiled costs for patients aged ≤61 years who received surgery for stage I-III breast cancer between January 1, 2016, and December 31, 2016, then, postoperatively through December 31, 2020. Treatment costs were compared annually by BCRL status (two or more vs. no BCRL diagnosis codes within 2 years of surgery). BCRL and non-BCRL cohorts were propensity-matched, accounting for surgery types, chemotherapy, and radiation. Sensitivity analyses determined cost differences by age at diagnosis (18-44 vs. 45-61 years).

[RESULTS] Of 2141 patients, 244 (11.4%) had BCRL. BCRL incidence was similar across ages: 46 of 434 (10.6%) aged 18-44 years versus 198 of 1707 (11.6%) aged 45-61 years; p = 0.612. Before matching, patients with BCRL had higher copayment ($US1200 vs. $US610 non-BCRL; p < 0.001) and payer costs ($US140,000 vs. $US76,000 non-BCRL; p < 0.001). After matching, copayment differences persisted ($US1200 BCRL vs. $US850 non-BCRL; p < 0.001). Among those aged 18-44 years, BCRL conferred lower out-of-pocket costs ($US2900 vs. $US23,000 non-BCRL; p = 0.031) but no difference in copayment/payer costs in years 1-2 or costs thereafter. Among those aged 45-61 years, only copayment costs were significant in year 3 (p = 0.014). Heat map analysis revealed that costs concentrated around chemotherapy for all ages; among younger women, BCRL represented the highest source of out-of-pocket spending after chemotherapy and reconstruction.

[CONCLUSION] Patients with BCRL incurred higher payer and copayment costs than those without. As differences may not emerge until survivorship, strategies to reduce financial toxicity should continue after cancer treatment.