BACKGROUND AND OBJECTIVES: The current healthcare climate demands evaluation of treatment modalities in terms of costs and benefits. We compared the cost-effectiveness of two different strategies for bilobar colorectal liver metastases (bCRLM). METHODS: Patients with bCRLM treated with either resection/RFA or planned 2-stage hepatectomy at our institution between 1999 and 2011 were reviewed. A decision analysis model was populated with treatment probabilities, outcomes, survival, and costs (Medicare payment, 2011 US$). RESULTS: Two hundred fourteen patients underwent resection/RFA. Eighty-two patients were treated with planned 2-stage hepatectomy; 26 (32%) patients never completed a 2nd resection. In the 2-stage cohort, 50 patients underwent portal vein embolization (PVE). Overall complication rate and 90-day mortality for resection/RFA was 36% and 3.7%, and for 2-stage hepatectomy (both procedures combined) was 44% and 7.3%, respectively. Cost-effectiveness analysis revealed that resection/RFA cost $37,120 for 46.2-month survival, while planned 2-stage resection cost $62,198 for 35.9-month survival. If, hypothetically, all 2-stage patients completed both stages of resection, the per-patient cost was $72,644 for 40.3-month survival. CONCLUSIONS: Resection/RFA is associated with lower costs and longer survival when compared to 2-stage resection. This 1-stage approach for bCRLM should be viewed as an efficient use of resources for this challenging clinical scenario.
BACKGROUND AND OBJECTIVES: The current healthcare climate demands evaluation of treatment modalities in terms of costs and benefits. We compared the cost-effectiveness of two different strategies for bilobar colorectal liver metastases (bCRLM). METHODS:Patients with bCRLM treated with either resection/RFA or planned 2-stage hepatectomy at our institution between 1999 and 2011 were reviewed. A decision analysis model was populated with treatment probabilities, outcomes, survival, and costs (Medicare payment, 2011 US$). RESULTS: Two hundred fourteen patients underwent resection/RFA. Eighty-two patients were treated with planned 2-stage hepatectomy; 26 (32%) patients never completed a 2nd resection. In the 2-stage cohort, 50 patients underwent portal vein embolization (PVE). Overall complication rate and 90-day mortality for resection/RFA was 36% and 3.7%, and for 2-stage hepatectomy (both procedures combined) was 44% and 7.3%, respectively. Cost-effectiveness analysis revealed that resection/RFA cost $37,120 for 46.2-month survival, while planned 2-stage resection cost $62,198 for 35.9-month survival. If, hypothetically, all 2-stage patients completed both stages of resection, the per-patient cost was $72,644 for 40.3-month survival. CONCLUSIONS: Resection/RFA is associated with lower costs and longer survival when compared to 2-stage resection. This 1-stage approach for bCRLM should be viewed as an efficient use of resources for this challenging clinical scenario.
Authors: Jeffrey M Sutton; Richard S Hoehn; Audrey E Ertel; Gregory C Wilson; Dennis J Hanseman; Koffi Wima; Jeffrey J Sussman; Syed A Ahmad; Shimul A Shah; Daniel E Abbott Journal: J Gastrointest Surg Date: 2015-10-01 Impact factor: 3.452
Authors: Giovanni Battista Levi Sandri; Roberto Santoro; Giovanni Vennarecci; Pasquale Lepiane; Marco Colasanti; Giuseppe Maria Ettorre Journal: Updates Surg Date: 2015-11-03
Authors: Daniel A Goldstein; Simon B Zeichner; Catherine M Bartnik; Eli Neustadter; Christopher R Flowers Journal: Clin Colorectal Cancer Date: 2015-10-22 Impact factor: 4.481
Authors: Guido Torzilli; René Adam; Luca Viganò; Katsunori Imai; Jeremias Goransky; Andrea Fontana; Christian Toso; Pietro Majno; Eduardo de Santibañes Journal: Liver Cancer Date: 2016-11-29 Impact factor: 11.740
Authors: Serge Evrard; Graeme Poston; Peter Kissmeyer-Nielsen; Abou Diallo; Grégoire Desolneux; Véronique Brouste; Caroline Lalet; Frank Mortensen; Stefan Stättner; Stephen Fenwick; Hassan Malik; Ioannis Konstantinidis; Ronald DeMatteo; Michael D'Angelica; Peter Allen; William Jarnagin; Simone Mathoulin-Pelissier; Yuman Fong Journal: PLoS One Date: 2014-12-08 Impact factor: 3.240