{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T06:57:45Z","timestamp":1782284265624,"version":"3.54.5"},"reference-count":10,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2020,3,23]],"date-time":"2020-03-23T00:00:00Z","timestamp":1584921600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Surgical Oncology"],"published-print":{"date-parts":[[2020,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background and Objectives<\/jats:title><jats:p>Prophylactic lymphovenous anastomosis (LVA) has been shown to decrease the incidence of postoperative lymphedema among patients receiving mastectomy with axillary lymph node dissection (ALND). However, the economic impact of this intervention on overall healthcare costs has not been adequately studied and insurance reimbursement for lymphedema treatment is limited resulting in substantial out\u2010of\u2010pocket patient expenses.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We performed a cost\u2010minimization decision analysis from the societal perspective to assess two different patient scenarios: (a) mastectomy with ALND alone, (b) mastectomy with ALND and prophylactic LVA.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The annual cost of lymphedema\u2010related care is estimated to be $5,691.88 ($3,160.52 direct, $2,531.36 indirect). If all patients undergoing mastectomy with ALND undergo prophylactic LVA, the average expected lifetime cost per patient in the entire population (whether or not they develop lymphedema) is approximately $6,295.61, compared to $13,942.26 if no patients in the same population receive prophylactic LVA.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Prophylactic LVA is economically preferred over mastectomy and ALND alone from a cost minimization perspective, and results in an average of $7,646.65 (45.2%) cost saving per patient over the course of their lifetime.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jso.25902","type":"journal-article","created":{"date-parts":[[2020,3,24]],"date-time":"2020-03-24T03:53:04Z","timestamp":1585021984000},"page":"1175-1178","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":32,"title":["An economic analysis of prophylactic lymphovenous anastomosis among breast cancer patients receiving mastectomy with axillary lymph node dissection"],"prefix":"10.1002","volume":"121","author":[{"given":"Lee","family":"Squitieri","sequence":"first","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, Keck School of Medicine University of Southern California  Los Angeles California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Petra W.","family":"Rasmussen","sequence":"additional","affiliation":[{"name":"Fielding School of Public Health, Department of Health Policy and Management University of California  Los Angeles California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6883-4816","authenticated-orcid":false,"given":"Ketan M.","family":"Patel","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, Keck School of Medicine University of Southern California  Los Angeles California"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,3,23]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(13)70076-7"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-018-4418-4"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.2522\/ptj.20100167"},{"key":"e_1_2_6_5_1","unstructured":"Center for Consumer Information and Insurance Oversight: Women's Health and Cancer Rights Act (WHCRA). Available at:https:\/\/www.cms.gov\/cciio\/programs\u2010and\u2010initiatives\/other\u2010insurance\u2010protections\/whcra_factsheet.html. Accessed 2\/2\/19."},{"key":"e_1_2_6_6_1","unstructured":"Lymphedema Treatment Act. Available at:https:\/\/lymphedematreatmentact.org\/about\u2010the\u2010bill\/background\u2010information\/. Accessed 5\/28\/19."},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/micr.30180"},{"key":"e_1_2_6_8_1","unstructured":"Surveillance Epidemiology and End Results (SEER) Program(www.seer.cancer.gov) Research Data (1973\u20102015) National Cancer Institute DCCPS Surveillance Research Program Released April 2018 based on the November 2017 Submission."},{"key":"e_1_2_6_9_1","unstructured":"Centers for Medicare and Medicaid Services Physician Fee Schedule. Available at:https:\/\/www.cms.gov\/Medicare\/Medicare\u2010Fee\u2010for\u2010Servcie\u2010Payment\/PhysicianFeeSched\/. Accessed 6\/13\/18."},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2017.6233"},{"key":"e_1_2_6_11_1","unstructured":"US Bureau of Labor Statistics:National Occupational Employment and Wage Estimates United States. Available at:https:\/\/www.bls.gov\/oes\/current\/oes_nat.htm#00\u20100000. Accessed 5\/28\/19."}],"container-title":["Journal of Surgical Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fjso.25902","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jso.25902","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/jso.25902","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jso.25902","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,6]],"date-time":"2023-09-06T11:49:57Z","timestamp":1694000997000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/jso.25902"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,3,23]]},"references-count":10,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2020,6]]}},"alternative-id":["10.1002\/jso.25902"],"URL":"https:\/\/doi.org\/10.1002\/jso.25902","archive":["Portico"],"relation":{},"ISSN":["0022-4790","1096-9098"],"issn-type":[{"value":"0022-4790","type":"print"},{"value":"1096-9098","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,3,23]]},"assertion":[{"value":"2019-11-04","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-02-05","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-03-23","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}