Breast Cancer Related Lymphedema: Cost of Illness and Cost Effectiveness of Alt

乳腺癌相关淋巴水肿(BCRL)是一种常见的、持续性的、进行性的乳腺癌诊断和治疗不良事件，因肥胖和久坐不动的生活方式而加重，其特征是手臂肿胀、功能受损和令人烦恼的症状。WISER生存者试验(项目2)将在绝经后肥胖和肥胖妇女的多种族队列中评估BCRL治疗的增量临床有效性(淋巴水肿症、蜂窝组织炎、生活质量)，仅运动、减肥 与常规护理对照组相比，仅限运动和减肥相结合。 虽然BCRL产生了大量的医疗费用(其中很大一部分由患者承担)，降低了生产率和生活质量，但经验数据很少。有效的行为干预措施，如运动训练和减肥，使BCRL暂时性、减轻其影响并防止病情进展，通常不会得到报销；第三方支付者很少支付缓解BCRL所需的用品。因此，目前的保险结构错误地将乳腺癌幸存者置于不必要的风险中 BCRL的不良事件和后遗症，可能会因下游并发症增加而增加成本(例如，反复发作性淋巴管炎和蜂窝织炎的门诊护理和住院；BRCL红斑和症状性恶化的物理治疗)。因此，迫切需要更好地描述BCRL的医疗经济影响及其短期和长期健康后果。 项目3将：(1)评估BCRL的直接医疗费用；(2)评估项目2 WISER Survivor干预措施的增量成本效益；以及(3)模拟较长时间框架内WISER Survivor干预措施的影响。开发新的方法学方法来定义和识别BCRL 结合和整合来自患者报告、行政索赔和电子病历的国家语言查询的数据的案例将成为识别和选择BCRL患者进行未来研究的标准，并建立替代方法的有效性，同时展示这种方法对其他医疗条件的可行性和潜在价值。

Breast cancer related lymphedema (BCRL), characterized by arm swelling, impaired function and bothersome symptoms, is a common, persistent, often progressive adverse event of breast cancer diagnosis and therapy, exacerbated by obesity and sedentary lifestyle. The WISER Survivor Trial (Project 2) will assess in a multi-ethnic cohort of ovenweight and obese post-menopausal women witht BCRL the incremental clinicai effectiveness (lymphedema flares, cellulitis, quality of life) of exercise only, weight loss only, and exercise and weight-loss combined compared with a usual care control group. While BCRL incurs substantial health care costs (significant portions of which are borne by patients), reduces productivity and reduces quality of life, empirical data are sparse. Effective behavioral interventions such as exercise training and weight loss that temporize BCRL, mitigate its impact and prevent progression often are not reimbursed; third party payers rarely cover supplies required to mitigate BCRL. As a consequence, the current insurance structure perversely places breast cancer survivors at needless risk of BCRL adverse events and sequellae and may increase costs as a result of increased downstream complications (e.g., outpatient care and hospitalizations for repeated episodic lymphangitis and cellulitis; physical therapy for BRCL flares and symptomatic exacerbations). Thus, there is a compelling need to better characterize the medical economic impact of BCRL, as well as its short- and long-term health consequences. Project 3 will; (1) assess BCRL direct medical care costs; (2) assess the incremental cost-effectiveness of the Project 2 WISER Survivor interventions; and (3) model the impact ofthe WISER Survivor interventions over an extended time frame. The novel methodological approaches developed to define and identify BCRL cases combining and integrating data from patient reports, administrative claims and national language queries of electronic medical records will inform criteria to identify and select BCRL patients for future studies, as well as establish the validity of alternative methods, while demonstrating the feasibility and potential value of this approach for other medical conditions.