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

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

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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Author notes

    Authors and Affiliations

    1. Department of Surgery, Division of Surgical Oncology, The Johns Hopkins Hospital, 600 N. Wolfe Street, Blalock 688, Baltimore, MD, 21287, USA

      Gaya Spolverato, Aslam Ejaz & Timothy M. Pawlik

    2. Unità di Chirurgia Epatobiliare e Trapianto Epatico, Azienda Ospedaliera-Università di Padova, Padova, Italy

      Alessandro Vitale & Umberto Cillo

    3. Department of Medical Oncology, The Johns Hopkins Hospital, Baltimore, MD, USA

      David Cosgrove & Darren Cowzer

    Authors
    1. Gaya Spolverato
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    2. Alessandro Vitale
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    3. Aslam Ejaz
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    4. David Cosgrove
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    5. Darren Cowzer
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    6. Umberto Cillo
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    7. Timothy M. Pawlik
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    Correspondence to Timothy M. Pawlik.

    Additional information

    Gaya Spolverato and Alessandro Vitale contributed equally to this work.

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    Supplementary Figure 1

    The event pathway: decision tree and states of health (GIF 117 kb)

    High Resolution Image (TIFF 1521 kb)

    Supplementary Figure 2

    Variation of Survival Benefit according to patient age ≤60 (A) or >60 (B) years and rate of true complete pathological response. (GIF 128 kb)

    (GIF 128 kb)

    High Resolution Image (TIFF 1521 kb)

    High Resolution Image (TIFF 1521 kb)

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    Spolverato, G., Vitale, A., Ejaz, A. et al. Hepatic Resection for Disappearing Liver Metastasis: a Cost-Utility Analysis. J Gastrointest Surg 19, 1668–1675 (2015). https://doi.org/10.1007/s11605-015-2873-5

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    • DOI: https://doi.org/10.1007/s11605-015-2873-5

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