Impact of Lymphedema in the Management of Venous Leg Ulcers

Introduction, Objectives, and/or Purpose: Lymphedema (LED) in patients with venous leg ulcers (VLU) [VLU+LED] can impair ulcer healing and predispose to cellulitis. There is little data, however, demonstrating how lymphatic dysfunction may impact the clinical course, treatment, and healthcare expenditures for VLU+LED versus VLU-LED patients. The goal of this study is to determine how lymphatic dysfunction might influence treatment and expenditures among VLU patients in a large de-identified healthcare claims database.

Methods: A retrospective cohort design and data from the IBM MarketScan Database (April 2012 to March 2020) were employed. Study population comprised VLU patients, and was stratified into two subgroups: VLU+LED (index date = date of first LED diagnosis) and VLU-LED (index dates randomly assigned to match distribution of index dates for VLU+LED). Within each subgroup, patients with < 1 year of healthcare claims information before and after index dates were excluded. Demographics, comorbidities, procedures/treatments, and all-cause post-index medical resource utilization and expenditures ($/patient/year) of the two groups were compared. Stabilized inverse probability treatment weights (IPTWs) were employed to adjust for differences between groups in baseline characteristics.

Results: A total of 5,466 VLU patients were identified (VLU+LED: N=299; VLU-LED: N=5,167). Overall ambulatory encounters (AMB ENC) and their components were higher in VLU+LED, which were reflected in increased expenditures for this group (Table I). Treatment with endovenous ablation (EVA) or stenting for venous hypertension as well as for specific measures for LED were higher in the one-year post-index period for VLU+LED. The use of LED specific therapy was low for both groups, but a greater % of VLU+LED patients received therapy, which was predominantly manual lymphatic drainage (17.4%) rather than pneumatic compression (10.7%).

Conclusion(s): The clinical presence of LED in patients with VLU is a marker for a more complex disease process with more episodes of cellulitis and expenditures, but a surprisingly low specific treatment for LED.