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A Comparison of Programmable and Non-Programmable Compression Devices for Treatment of Lymphedema Using an Administrative Health Outcomes Dataset. British journal of dermatology Karaca-Mandic, P., Hirsch, A. T., Rockson, S. G., Ridner, S. H. 2017

Abstract

Patients with lymphedema suffer lifelong swelling and recurrent cellulitis despite use of complete decongestive therapy. Pneumatic compression devices (PCDs), including non-programmable and programmable devices that meet individual patient needs, support long term self-care in the home. Yet, to date, no direct comparison of their relative benefits has been available.Patients who acquired either a non-programmable device (NP-PCD) or a dynamic pressure programmable device (P-PCD; Flexitouch(®) ) were evaluated to compare associated clinical and health utilization outcomes pre/post-device acquisition.Retrospective analysis of de-identified administrative claims from 2007 through 2013 of a large United States insurer. The study populations were defined pre hoc as distinct cancer- and non-cancer-related lymphedema cohorts. Outcome variables included rates of lymphedema-related cellulitis, manual therapy use, outpatient services, and inpatient hospitalizations. Multivariate regression analysis was performed to: (1) compare outcomes for the 12 months pre- and post-device acquisition and (2) compare these two device types for their treatment-associated benefits.The sample consisted of 1,013 NP-PCD and 718 P-PCD recipients. Compared with the NP-PCD group, P-PCD patients' baseline cellulitis rate was higher, while their post-device cellulitis rate was lower. In the cancer cohort, the NP-PCD group had a 53% reduction in episodes of cellulitis (from 17.9% to 8.5%), compared to a greater 79% reduction in the P-PCD group (from 23.7% to 5.0%) (p<0.001). In the non-cancer cohort, the P-PCD group also experienced a larger 76% decline (from 31.7% to 7.4%) vs. 54% decline (from 22.9% to 10.6%) in cellulitis rates (p=0.003). Outpatient service use reduced in both device groups, with greater reductions observed in P-PCD group. Both device groups experienced reductions in manual therapy use. Inpatient hospitalizations were largely stable with reductions observed only in the non-cancer cohort of the P-PCD group.P-PCD receipt was associated with superior lymphedema-related health outcomes and reductions in cellulitis. This article is protected by copyright. All rights reserved.

View details for DOI 10.1111/bjd.15699

View details for PubMedID 28573790