Objectives
Lymphoedema is an important cause of morbidity in the population, but little is known of its epidemiology and impact on patients or health services. Thus we looked for use of manual lymphatic drainage (MLD) in Germany with its unique health system to see any trend in the prescription of MLD and tried to draw conclusions regarding the number of possible affected people.
Subjects and methods
Roughly 90% of the population in Germany is statutorily insured and the statutory health insurance (SHI) publishes quarterly federal reports based on the unaudited, service-provided billing records. From these reports we extracted data regarding the general costs and numbers of MLD 45 (manual lymphatic drainage sessions of 45 min length) and MLD 60 (60 min length) prescribed annually in Germany.
Results
In 2010 the cost for MLD 45 and MLD 60 only were 408.7 million €. The cost increased from 226.4 million € in 2004. MLD 45 was more frequently prescribed than MLD 60. The cost for MLD 45 and MLD 60 increased disproportionately compared to the other cost. The rate of costs for MLD 45 increased from 3.6% in 2004 to 5.4% in 2010 and that for MLD 60 from 2.7 to 3.9%. Together the rate for MLD increased from 6.3 to 9.5%. In 2010, MLD 45 sessions totaled up to 11,659,815, while MLD 60 sessions totaled 5,379,076. Accepting that a patient suffering from lymphoedema needs a minimum of 1 session of MLD a week, 327,671 patients could have theoretically received MLD, whereas postulating that people suffering from lymphoedema need MLD three times a week, only 109,224 could have received adequate treatment.
Conclusion
Of all the costs that are spent on treatments in Germany in 2010 at least 9.5% are associated with MLD and the proportion has risen even faster than the total costs indicating an increasing need for MLD.