Meta-Analysis of a Large & Clinically Heterogeneous Evidence Base:
Maximizing Available Evidence Regarding Progression to Chronic Breast Cancer-Related Lymphedema


The client needed to synthesize evidence regarding progression to chronic breast cancer-related lymphedema (BCRL) among patients receiving surgery for breast cancer, when monitored using the client’s bioimpedance spectroscopy (BIS) device to detect subclinical lymphedema and trigger early intervention. In order to ensure that the resultant meta-analysis could withstand the scrutiny necessary for a top-tier peer-reviewed publication, TTi conducted a systematic literature review to identify eligible studies and performed a robust meta-analysis, adhering to precise data abstraction methodologies and in accordance with best practices, including PRISMA. The analysis demonstrated the absolute and relative reduction in BCRL when monitoring and early detection is implemented using BIS, comparing the client’s technology to both limb circumference monitoring with tape measure and to no monitoring (the background rate of progression). TTi developed a peer-reviewed manuscript communicating the results of the meta-analysis which is currently being prepared for submission. This work was accepted for presentation at ISPOR 2020 and the abstract was published in Value in Health.