A Comparison of Programmable and Non-Programmable Compression Devices for Treatment of Lymphedema Using an Administrative Health Outcomes Dataset

Abstract

Background

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.

Objective

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.

Methods

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.

Results

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.

Conclusions

P-PCD receipt was associated with superior lymphedema-related health outcomes and reductions in cellulitis.

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