What are the economic burden and costs associated with the treatment of breast cancer-related lymphoedema? A systematic review

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To provide an overview of costs associated with the treatment of breast cancer-related lymphoedema (BCRL) and its possible sequelae, borne by patients or by society.

Data sources

According to the PRISMA guideline, a systematic literature search was carried out in four electronic databases: PubMed, Web of Science, Cochrane Clinical Trials and EMBASE. Searches were performed on October 1, 2018.

Study selection

Eligibility criteria: (1) expenses of adults (age > 18 years), (2) concerning patients with BCRL, (3) overview of (in)direct costs associated with BCRL, (4) expenses in which at least one type of conservative treatment modality for lymphoedema is included and/or costs for hospital admissions due to infections. Reviews and meta-analyses were excluded.

Data extraction

After assessing the risk of bias and level of evidence, quantitative data on (in)direct costs for BCRL treatment during a well-mentioned timeframe were extracted.

Data synthesis

Eight studies were included. Three studies reported on patient-borne costs related to BCRL. Mean direct costs per year borne by patients ranged between USD$2306 and USD$2574. Indirect costs borne by patients ranged between USD$3325 and USD$5545 per year. Five studies estimated society-borne costs related to BCRL from claims data, billing prices and providers’ services during 12 to 24 months of follow-up. Mean direct treatment costs after 1 year of decongestive lymphatic therapy (DLT) ranged between €799 (= USD$1126.60) and USD$3165.


This systematic review revealed that BCRL imposes a substantial economic burden on patients and society. However, more standardized high-quality health economic analyses among this field are required. Recent economic analyses related to BCRL treatment in Europe, Asia, Africa and South America are lacking. Worldwide, further scrutiny of the economic impact of DLT for BCRL in clinical settings is needed.

Clinical trial registration number

The review makes part of a double-blind, multi-center, randomized controlled trial (EFforT-BCRL trial), which is registered in (NCT02609724). CME reference S58689, EudraCT Number 2015-004822-33.

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All authors critically revised the manuscript for important intellectual content and approved the final manuscript.

Funding information

This review is financed by the Agency for Innovation by Science and Technology, applied Biomedical Research (IWT 150178). In order to arrange such financing, a separate collaboration agreement has been signed by the KU Leuven and the beneficiaries.

Author information

Correspondence to Tessa De Vrieze.

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Conflict of interest

The authors declare that they have no conflicts of interest.

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Support statement: ADG is a post-doctoral research fellow of the FWO-Flanders.

Appendix. Overview of the Boolean search strategies used in the different databases

Appendix. Overview of the Boolean search strategies used in the different databases

PubMed 1-10-2018
(‘Health Care Costs’[Mesh] OR ‘Health Care Costs’[All Fields] OR ‘Costs and Cost Analysis’[Mesh] OR ‘health care economics’[All Fields] OR ‘Costs and Cost Analysis’[All Fields] OR ‘Cost-Benefit Analysis’[Mesh] OR ‘Cost-Benefit Analysis’[All Fields] OR ‘Cost of Illness’[Mesh] OR ‘Cost of Illness’[All Fields] OR ‘Cost-of-illness’[All Fields] OR ‘Hospital Costs’[Mesh] OR ‘Hospital Costs’[All Fields] OR ‘Health Expenditures’[Mesh] OR ‘Health Expenditures’[All Fields] OR ‘Cost’[All Fields] OR ‘cost evaluation’[All Fields] OR ‘economic evaluation’[All Fields] OR ‘cost analysis’[All Fields] OR ‘economic analysis’[All Fields] OR ‘cost effectiveness’[All Fields]) AND (‘lymphedema’[MeSH Terms] OR ‘lymphoedema’[All Fields] OR ‘lymphedema’[All Fields]) AND (‘breast neoplasms’[All Fields] OR ‘breast neoplasms’[MeSH] OR ‘breast cancer’[All Fields] OR ‘costs’[All Fields] OR ‘breast cancer treatment’[All Fields] OR ‘direct costs’[All Fields] OR ‘health outcomes’[All Fields] OR ‘upper limb’[All Fields])
Web of Science 1-10-2018
(TS=((‘Health Care Costs’ OR (‘Health’ AND ‘Care’ AND ‘Costs’) OR ‘Cost Analysis’ OR (‘costs’ AND ‘analysis’) OR ‘health care economics’ OR (‘health’ AND ‘care’ AND ‘economics’) OR ‘Cost-Benefit Analysis’ OR (‘cost-benefit’ AND ‘analysis’) OR ‘Cost of Illness’ OR (‘cost’ AND ‘illness’) OR ‘Hospital Costs’ OR (‘Hospital’ AND ‘Costs’) OR ‘Health Expenditures’ OR (‘Health’ AND ‘Expenditures’) OR ‘Cost’ OR ‘cost evaluation’ OR (‘cost’ AND ‘evaluation’) OR ‘economic evaluation’ OR (‘economic’ AND ‘evaluation’) OR ‘direct costs’ OR (‘direct’ AND ‘costs’) OR ‘health outcomes’ OR (‘health’ AND ‘outcomes’) OR ‘economic analysis’ OR (‘economic’ AND ‘analysis’) OR ‘cost effectiveness’ OR (‘cost’ AND ‘effectiveness’)) AND (‘lymphedema’ OR ‘lymphoedema’) AND (‘breast neoplasms’ OR (‘breast’ AND ‘neoplasms’) OR ‘breast cancer’ OR (‘breast’ AND ‘cancer’) OR ‘lymphedema treatment’ OR (‘lymphedema’ AND ‘treatment’) OR ‘upper limb’ OR (‘upper’ AND ‘limb’)))) AND DOCUMENT TYPES: (Article)
Cochrane Clinical Trials 1-10-2018
((‘Health Care Costs’ OR ‘Costs and Cost Analysis’ OR ‘health care economics’ OR ‘Cost-Benefit Analysis’ OR ‘Cost of Illness’ OR ‘Cost-of-illness’ OR ‘Hospital Costs’ OR ‘Health Expenditures’ OR ‘Cost’ OR ‘cost evaluation’ OR ‘economic evaluation’ OR ‘cost analysis’ OR ‘economic analysis’ OR ‘cost effectiveness’ OR ‘direct costs’ OR ‘health outcomes’) AND (‘lymphedema’ OR ‘lymphoedema’) AND (‘breast neoplasms’ OR ‘breast cancer’ OR ‘lymphedema treatment’ OR ‘upper limb’)) in Title Abstract Keyword
EMBASE 1-10-2018
(‘health care cost’/exp OR ‘health care cost’ OR ‘cost analysis’/exp OR ‘cost analysis’ OR ‘costs’ OR ‘health care economics’/exp OR ‘health care economics’ OR ‘cost-benefit analysis’/exp OR ‘cost-benefit analysis’ OR ‘cost of illness’/exp OR ‘cost of illness’ OR ‘hospital costs’/exp OR ‘hospital costs’ OR ‘health expenditures’/exp OR ‘health expenditures’ OR ‘cost evaluation’ OR ‘economic evaluation’/exp OR ‘economic evaluation’ OR ‘direct costs’ OR ‘health outcomes’/exp OR ‘health outcomes’ OR ‘economic analysis’ OR ‘cost effectiveness’/exp OR ‘cost effectiveness’) AND (‘lymphedema’/exp OR ‘lymphedema’ OR ‘lymphoedema’/exp OR ‘lymphoedema’) AND (‘breast neoplasms’/exp OR ‘breast neoplasms’ OR ‘breast cancer’/exp OR ‘breast cancer’ OR ‘lymphedema treatment’ OR ‘upper limb’/exp OR ‘upper limb’) AND ([article]/lim OR [article in press]/lim) AND [humans]/lim

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De Vrieze, T., Nevelsteen, I., Thomis, S. et al. What are the economic burden and costs associated with the treatment of breast cancer-related lymphoedema? A systematic review. Support Care Cancer 28, 439–449 (2020).

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  • Breast cancer
  • Breast neoplasms
  • Lymphedema
  • Healthcare costs
  • Costs and cost analysis