Liver Resection for Advanced Intrahepatic Cholangiocarcinoma: A Cost-Utility Analysis

Umberto Cillo, Gaya Spolverato, Alessandro Vitale, Aslam Ejaz, Sara Lonardi, David Cosgrove, Timothy M. Pawlik

Research output: Contribution to journalArticle

Abstract

Background: Data on cost-effectiveness and efficacy of hepatic resection (HR) for advanced intrahepatic cholangiocarcinoma (ICC) are lacking. We sought to estimate the cost-effectiveness of upfront HR resulting in an R1 resection (strategy A) relative to initial systemic chemotherapy (sCT) followed by possible curative HR (strategy B) for patients with advanced ICC. Methods: A Markov model was developed using data from a systematic literature review. Three base cases were considered: (1) ICC >6 cm (2) ICC with vascular invasion (3) multi-focal ICC. A Monte Carlo simulation assessed outcomes including quality-adjusted life months (QALMs) and incremental cost-effectiveness ratio (ICER). Results: The net health benefit (NHB) of strategy A versus strategy B was 1.4 QALMs for ICC >6 cm and 1.3 QALMs for ICC and vascular invasion; in contrast, there was a negative NHB for HR versus sCT for multi-focal ICC (-0.3 QALMs). In single nodule ICC >6 cm, the ICER of HR versus sCT was $22,482/quality-adjusted life years (QALY) and the ICER of HR versus sCT was $20,953/QALY for ICC with vascular invasion. In multi-focal ICC, the ICER of HR compared with sCT was $83,604/QALY. Patients with a higher American Society of Anesthesiologists score (coefficient 0.94), male sex (coefficient 0.43), low quality of life after sCT (coefficient -2.57) and T3 tumors (coefficient 0.53) had a better NHB for HR relative to sCT followed by potential surgery. Conclusions: For patients with large ICC or ICC and vascular invasion, HR was more cost-effective than sCT. In contrast, HR was not associated with a positive NHB relative to sCT for patients with multi-focal ICC, and therefore these patients should be treated with sCT rather than HR.

Original languageEnglish (US)
Article number3150
Pages (from-to)2500-2509
Number of pages10
JournalWorld Journal of Surgery
Volume39
Issue number10
DOIs
StatePublished - Oct 1 2015

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Cholangiocarcinoma
Cost-Benefit Analysis
Liver
Drug Therapy
Insurance Benefits
Quality of Life
Blood Vessels
Quality-Adjusted Life Years

ASJC Scopus subject areas

  • Surgery

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Cillo, U., Spolverato, G., Vitale, A., Ejaz, A., Lonardi, S., Cosgrove, D., & Pawlik, T. M. (2015). Liver Resection for Advanced Intrahepatic Cholangiocarcinoma: A Cost-Utility Analysis. World Journal of Surgery, 39(10), 2500-2509. [3150]. https://doi.org/10.1007/s00268-015-3150-1

Liver Resection for Advanced Intrahepatic Cholangiocarcinoma : A Cost-Utility Analysis. / Cillo, Umberto; Spolverato, Gaya; Vitale, Alessandro; Ejaz, Aslam; Lonardi, Sara; Cosgrove, David; Pawlik, Timothy M.

In: World Journal of Surgery, Vol. 39, No. 10, 3150, 01.10.2015, p. 2500-2509.

Research output: Contribution to journalArticle

Cillo, U, Spolverato, G, Vitale, A, Ejaz, A, Lonardi, S, Cosgrove, D & Pawlik, TM 2015, 'Liver Resection for Advanced Intrahepatic Cholangiocarcinoma: A Cost-Utility Analysis', World Journal of Surgery, vol. 39, no. 10, 3150, pp. 2500-2509. https://doi.org/10.1007/s00268-015-3150-1
Cillo U, Spolverato G, Vitale A, Ejaz A, Lonardi S, Cosgrove D et al. Liver Resection for Advanced Intrahepatic Cholangiocarcinoma: A Cost-Utility Analysis. World Journal of Surgery. 2015 Oct 1;39(10):2500-2509. 3150. https://doi.org/10.1007/s00268-015-3150-1
Cillo, Umberto ; Spolverato, Gaya ; Vitale, Alessandro ; Ejaz, Aslam ; Lonardi, Sara ; Cosgrove, David ; Pawlik, Timothy M. / Liver Resection for Advanced Intrahepatic Cholangiocarcinoma : A Cost-Utility Analysis. In: World Journal of Surgery. 2015 ; Vol. 39, No. 10. pp. 2500-2509.
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AU - Cillo, Umberto

AU - Spolverato, Gaya

AU - Vitale, Alessandro

AU - Ejaz, Aslam

AU - Lonardi, Sara

AU - Cosgrove, David

AU - Pawlik, Timothy M.

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N2 - Background: Data on cost-effectiveness and efficacy of hepatic resection (HR) for advanced intrahepatic cholangiocarcinoma (ICC) are lacking. We sought to estimate the cost-effectiveness of upfront HR resulting in an R1 resection (strategy A) relative to initial systemic chemotherapy (sCT) followed by possible curative HR (strategy B) for patients with advanced ICC. Methods: A Markov model was developed using data from a systematic literature review. Three base cases were considered: (1) ICC >6 cm (2) ICC with vascular invasion (3) multi-focal ICC. A Monte Carlo simulation assessed outcomes including quality-adjusted life months (QALMs) and incremental cost-effectiveness ratio (ICER). Results: The net health benefit (NHB) of strategy A versus strategy B was 1.4 QALMs for ICC >6 cm and 1.3 QALMs for ICC and vascular invasion; in contrast, there was a negative NHB for HR versus sCT for multi-focal ICC (-0.3 QALMs). In single nodule ICC >6 cm, the ICER of HR versus sCT was $22,482/quality-adjusted life years (QALY) and the ICER of HR versus sCT was $20,953/QALY for ICC with vascular invasion. In multi-focal ICC, the ICER of HR compared with sCT was $83,604/QALY. Patients with a higher American Society of Anesthesiologists score (coefficient 0.94), male sex (coefficient 0.43), low quality of life after sCT (coefficient -2.57) and T3 tumors (coefficient 0.53) had a better NHB for HR relative to sCT followed by potential surgery. Conclusions: For patients with large ICC or ICC and vascular invasion, HR was more cost-effective than sCT. In contrast, HR was not associated with a positive NHB relative to sCT for patients with multi-focal ICC, and therefore these patients should be treated with sCT rather than HR.

AB - Background: Data on cost-effectiveness and efficacy of hepatic resection (HR) for advanced intrahepatic cholangiocarcinoma (ICC) are lacking. We sought to estimate the cost-effectiveness of upfront HR resulting in an R1 resection (strategy A) relative to initial systemic chemotherapy (sCT) followed by possible curative HR (strategy B) for patients with advanced ICC. Methods: A Markov model was developed using data from a systematic literature review. Three base cases were considered: (1) ICC >6 cm (2) ICC with vascular invasion (3) multi-focal ICC. A Monte Carlo simulation assessed outcomes including quality-adjusted life months (QALMs) and incremental cost-effectiveness ratio (ICER). Results: The net health benefit (NHB) of strategy A versus strategy B was 1.4 QALMs for ICC >6 cm and 1.3 QALMs for ICC and vascular invasion; in contrast, there was a negative NHB for HR versus sCT for multi-focal ICC (-0.3 QALMs). In single nodule ICC >6 cm, the ICER of HR versus sCT was $22,482/quality-adjusted life years (QALY) and the ICER of HR versus sCT was $20,953/QALY for ICC with vascular invasion. In multi-focal ICC, the ICER of HR compared with sCT was $83,604/QALY. Patients with a higher American Society of Anesthesiologists score (coefficient 0.94), male sex (coefficient 0.43), low quality of life after sCT (coefficient -2.57) and T3 tumors (coefficient 0.53) had a better NHB for HR relative to sCT followed by potential surgery. Conclusions: For patients with large ICC or ICC and vascular invasion, HR was more cost-effective than sCT. In contrast, HR was not associated with a positive NHB relative to sCT for patients with multi-focal ICC, and therefore these patients should be treated with sCT rather than HR.

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