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Hepatic Resection for Disappearing Liver Metastasis: a Cost-Utility Analysis
- Source :
- Journal of Gastrointestinal Surgery. 19:1668-1675
- Publication Year :
- 2015
- Publisher :
- Springer Science and Business Media LLC, 2015.
-
Abstract
- We sought to estimate the cost-effectiveness of hepatic resection (HR) (strategy A) relative to surveillance plus 6 months of additional systemic chemotherapy (sCT) (strategy B) for patients with colorectal disappearing liver metastases (DLM). A Markov model was developed using data from a systematic literature review. Three base cases were evaluated: (1) a 60-year-old patient with three lesions in the right hemi-liver who underwent 6 months of sCT, had normalized carcinoembryonic antigen (CEA), and was diagnosed with DLM through a computed tomography (CT) scan; (2) a 60-year-old patient with three lesions in the right hemi-liver who underwent 6 months of sCT, had normalized CEA, and was diagnosed with DLM through a magnetic resonance imaging (MRI) scan; and (3) a 60-year-old patient with three lesions in the right hemi-liver who underwent 6 months of sCT plus hepatic artery infusion (HAI), had normalized CEA, and was diagnosed with DLM through a MRI scan. The outcomes evaluated were quality-adjusted life months (QALMs), incremental cost-effectiveness ratio (ICER), and net health benefit (NHB). The NHB of strategy A versus strategy B was positive in base case 1 (7.7 QALMs, ICER $34.449/quality-adjusted life year (QALY)) and base case 2 (1.6 QALMs, ICER $43,948/QALY). In contrast it was negative (−0.2 QALMs, ICER $72,474/QALY) for base case 3. Monte Carlo simulation showed that strategy B is acceptable only in old patients (>60 years) with normalized CEA and MRI-based diagnosis. In younger patients, strategy B may reach cost-effectiveness only after sCT plus HAI. Surveillance of DLM after sCT was more beneficial and cost-effective among patients >60 years with multiple factors predictive of true complete pathological response, such as normalization of CEA, HAI therapy, BMI ≤30 kg/m2, and diagnosis of DLM made through MRI.
- Subjects :
- Male
medicine.medical_specialty
Hepatic resection
Cost-Benefit Analysis
medicine.medical_treatment
Antineoplastic Agents
Outcomes
Metastasis
Carcinoembryonic antigen
Quality of life
Markov
Disappearing
Hepatectomy
Humans
Medicine
Liver metastasis
Tomography
Colorectal
Cost–utility analysis
medicine.diagnostic_test
biology
business.industry
Medicine (all)
Liver Neoplasms
Gastroenterology
Magnetic resonance imaging
Middle Aged
medicine.disease
Magnetic Resonance Imaging
Markov Chains
X-Ray Computed
Quality-adjusted life year
Surgery
Colorectal Neoplasms
Female
Quality of Life
Quality-Adjusted Life Years
Tomography, X-Ray Computed
biology.protein
Radiology
business
Subjects
Details
- ISSN :
- 18734626 and 1091255X
- Volume :
- 19
- Database :
- OpenAIRE
- Journal :
- Journal of Gastrointestinal Surgery
- Accession number :
- edsair.doi.dedup.....afa1d17570b2787918f63fe7d5d3f23d