Hepatic Resection for Disappearing Liver Metastasis: a Cost-Utility Analysis

Gaya Spolverato, Alessandro Vitale, Aslam Ejaz, David Cosgrove, Darren Cowzer, Umberto Cillo, Timothy M. Pawlik

Research output: Contribution to journalArticle

Abstract

Background: 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). Methods: 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). Results: 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. Conclusion: 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.

Original languageEnglish (US)
Pages (from-to)1668-1675
Number of pages8
JournalJournal of Gastrointestinal Surgery
Volume19
Issue number9
DOIs
StatePublished - Jun 16 2015

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Cost-Benefit Analysis
Neoplasm Metastasis
Liver
Carcinoembryonic Antigen
Drug Therapy
Quality-Adjusted Life Years
Hepatic Artery
Quality of Life
Magnetic Resonance Imaging
Insurance Benefits
Tomography
Costs and Cost Analysis

Keywords

  • Colorectal
  • Disappearing
  • Liver metastasis
  • Markov
  • Outcomes

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

Cite this

Spolverato, G., Vitale, A., Ejaz, A., Cosgrove, D., Cowzer, D., Cillo, U., & Pawlik, T. M. (2015). Hepatic Resection for Disappearing Liver Metastasis: a Cost-Utility Analysis. Journal of Gastrointestinal Surgery, 19(9), 1668-1675. https://doi.org/10.1007/s11605-015-2873-5

Hepatic Resection for Disappearing Liver Metastasis : a Cost-Utility Analysis. / Spolverato, Gaya; Vitale, Alessandro; Ejaz, Aslam; Cosgrove, David; Cowzer, Darren; Cillo, Umberto; Pawlik, Timothy M.

In: Journal of Gastrointestinal Surgery, Vol. 19, No. 9, 16.06.2015, p. 1668-1675.

Research output: Contribution to journalArticle

Spolverato, G, Vitale, A, Ejaz, A, Cosgrove, D, Cowzer, D, Cillo, U & Pawlik, TM 2015, 'Hepatic Resection for Disappearing Liver Metastasis: a Cost-Utility Analysis', Journal of Gastrointestinal Surgery, vol. 19, no. 9, pp. 1668-1675. https://doi.org/10.1007/s11605-015-2873-5
Spolverato G, Vitale A, Ejaz A, Cosgrove D, Cowzer D, Cillo U et al. Hepatic Resection for Disappearing Liver Metastasis: a Cost-Utility Analysis. Journal of Gastrointestinal Surgery. 2015 Jun 16;19(9):1668-1675. https://doi.org/10.1007/s11605-015-2873-5
Spolverato, Gaya ; Vitale, Alessandro ; Ejaz, Aslam ; Cosgrove, David ; Cowzer, Darren ; Cillo, Umberto ; Pawlik, Timothy M. / Hepatic Resection for Disappearing Liver Metastasis : a Cost-Utility Analysis. In: Journal of Gastrointestinal Surgery. 2015 ; Vol. 19, No. 9. pp. 1668-1675.
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abstract = "Background: 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). Methods: 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). Results: 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. Conclusion: 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.",
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AU - Cosgrove, David

AU - Cowzer, Darren

AU - Cillo, Umberto

AU - Pawlik, Timothy M.

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N2 - Background: 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). Methods: 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). Results: 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. Conclusion: 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.

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