Net health benefit of hepatic resection versus intraarterial therapies for neuroendocrine liver metastases: A Markov decision model

Gaya Spolverato, Alessandro Vitale, Aslam Ejaz, Yuhree Kim, David Cosgrove, Todd Schlacter, Jean Francis Geschwind, Timothy M. Pawlik

Research output: Contribution to journalArticle

Abstract

Background Management of patients with neuroendocrine liver metastasis (NELM) remains controversial. We sought to compare the net health benefit (NHB) of hepatic resection (HR) versus intraarterial therapy (IAT) among patients with NELM. Methods A decision analytic Markov model was created to estimate and compare the cost effectiveness associated with different management strategies (HR vs IAT) for a simulated cohort of patients with NELM. The primary (base case) analysis was calculated based on a 57-year-old male patient with metachronous, symptomatic NELM that involved 60 years) with extrahepatic disease and synchronous NELM. In contrast, in patients with nonfunctioning/asymptomatic NELM, hepatic tumor burden was the most important variable and HR was always cost ineffective in large tumors, independent of patient age and extrahepatic disease characteristics. Conclusion A Markov decision model demonstrated that HR was the preferred strategy among patients with symptomatic NELM, regardless of hepatic disease burden. In contrast, IAT should be preferred for patients with large volume nonfunctioning/asymptomatic NELM.

Original languageEnglish (US)
Pages (from-to)339-348
Number of pages10
JournalSurgery
Volume158
Issue number2
DOIs
StatePublished - Aug 1 2015

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Insurance Benefits
Neoplasm Metastasis
Liver
Therapeutics
Tumor Burden
Cost-Benefit Analysis

ASJC Scopus subject areas

  • Surgery
  • Medicine(all)

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Spolverato, G., Vitale, A., Ejaz, A., Kim, Y., Cosgrove, D., Schlacter, T., ... Pawlik, T. M. (2015). Net health benefit of hepatic resection versus intraarterial therapies for neuroendocrine liver metastases: A Markov decision model. Surgery, 158(2), 339-348. https://doi.org/10.1016/j.surg.2015.03.033

Net health benefit of hepatic resection versus intraarterial therapies for neuroendocrine liver metastases : A Markov decision model. / Spolverato, Gaya; Vitale, Alessandro; Ejaz, Aslam; Kim, Yuhree; Cosgrove, David; Schlacter, Todd; Geschwind, Jean Francis; Pawlik, Timothy M.

In: Surgery, Vol. 158, No. 2, 01.08.2015, p. 339-348.

Research output: Contribution to journalArticle

Spolverato, G, Vitale, A, Ejaz, A, Kim, Y, Cosgrove, D, Schlacter, T, Geschwind, JF & Pawlik, TM 2015, 'Net health benefit of hepatic resection versus intraarterial therapies for neuroendocrine liver metastases: A Markov decision model', Surgery, vol. 158, no. 2, pp. 339-348. https://doi.org/10.1016/j.surg.2015.03.033
Spolverato, Gaya ; Vitale, Alessandro ; Ejaz, Aslam ; Kim, Yuhree ; Cosgrove, David ; Schlacter, Todd ; Geschwind, Jean Francis ; Pawlik, Timothy M. / Net health benefit of hepatic resection versus intraarterial therapies for neuroendocrine liver metastases : A Markov decision model. In: Surgery. 2015 ; Vol. 158, No. 2. pp. 339-348.
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AB - Background Management of patients with neuroendocrine liver metastasis (NELM) remains controversial. We sought to compare the net health benefit (NHB) of hepatic resection (HR) versus intraarterial therapy (IAT) among patients with NELM. Methods A decision analytic Markov model was created to estimate and compare the cost effectiveness associated with different management strategies (HR vs IAT) for a simulated cohort of patients with NELM. The primary (base case) analysis was calculated based on a 57-year-old male patient with metachronous, symptomatic NELM that involved 60 years) with extrahepatic disease and synchronous NELM. In contrast, in patients with nonfunctioning/asymptomatic NELM, hepatic tumor burden was the most important variable and HR was always cost ineffective in large tumors, independent of patient age and extrahepatic disease characteristics. Conclusion A Markov decision model demonstrated that HR was the preferred strategy among patients with symptomatic NELM, regardless of hepatic disease burden. In contrast, IAT should be preferred for patients with large volume nonfunctioning/asymptomatic NELM.

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