Gestión económica del tratamiento del linfedema / Economic management of lymphoedema treatment

RESUMEN

Objetivo. Análisis comparativo del coste del tratamiento del linfedema de miembro superior secundario a cáncer de mama, aplicando un modelo tradicional versus un modelo de vigilancia prospectiva. Cuantificar el ahorro derivado del abordaje prospectivo poscirugía. Pacientes y métodos. Estudio retrospectivo de costes asociados al tratamiento del linfedema en el Hospital Ramón y Cajal y centros concertados. Se valoran 1.400 pacientes en consulta durante el año 2014; de ellos, 212 precisaron terapia física compleja o de mantenimiento. Las variables analizadas son los costes directos, los costes indirectos y el ahorro estimado. Resultados. El coste anual por paciente del tratamiento tradicional en el linfedema, a base de terapia física compleja en estadios, avanzados es 2.500 € aproximadamente. En el modelo prospectivo todos los pacientes acuden a la Escuela de Linfedema y son evaluados posquirúrgicamente. No suelen requerir terapia descongestiva, ni vendajes continuados y permite usar mangas prefabricadas menos costosas. Se evitan consultas y costes indirectos. Se incluye el coste del cribado y de la intervención en estadios iniciales. El coste anual es aproximadamente el 25% de la cantidad estimada en el enfoque tradicional, unos 700 € aproximadamente. Conclusiones. La vigilancia prospectiva en el linfedema puede reducir la necesidad de rehabilitación intensiva y es coste-efectiva. Supone un ahorro potencial del 75% del coste asociado al modelo tradicional vigente (AU)

ABSTRACT

Objectives. To conduct a comparative analysis of the cost of treatment of upper limb lymphoedema secondary to breast cancer, using a traditional model versus a prospective surveillance model. To quantify the savings from a prospective postoperative approach. Patients and methods. Retrospective study of the costs associated with lymphoedema treatment at the Ramon y Cajal Hospital and private centres. A total of 1,400 patients were assessed in medical consultations in 2014; of these, 212 were treated with complex decongestive therapy or maintenance therapy. The variables analysed were direct costs, indirect costs and estimated savings. Results. The annual cost per patient of traditional lymphoedema treatment, based on complex physical therapy in advanced stages, was approximately €2,500. In the prospective model, all patients attended the Lymphoedema Clinic and were also evaluated postsurgically. They did not usually require decongestive therapy or bandages and containment systems and were able to use prefabricated sleeves, which are considerably cheaper. Consultations and indirect costs were avoided. The cost of screening and intervention in the early stages was included. The annual cost was about 25% of the estimated amount with the traditional approach, approximately €700. Conclusions. Prospective lymphoedema surveillance can reduce the need for intensive rehabilitation and is cost-effective. It represents a potential saving of 75% of the cost associated with the traditional model (AU)