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/m(2), and diagnosis of DLM made through MRI.
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/m(2), and diagnosis of DLM made through MRI.
Authors: Bernard Nordlinger; Halfdan Sorbye; Bengt Glimelius; Graeme J Poston; Peter M Schlag; Philippe Rougier; Wolf O Bechstein; John N Primrose; Euan T Walpole; Meg Finch-Jones; Daniel Jaeck; Darius Mirza; Rowan W Parks; Murielle Mauer; Erik Tanis; Eric Van Cutsem; Werner Scheithauer; Thomas Gruenberger Journal: Lancet Oncol Date: 2013-10-11 Impact factor: 41.316
Authors: Skye C Mayo; Carlo Pulitano; Hugo Marques; Jorge Lamelas; Christopher L Wolfgang; Wassila de Saussure; Michael A Choti; Isabelle Gindrat; Luca Aldrighetti; Eduardo Barrosso; Gilles Mentha; Timothy M Pawlik Journal: J Am Coll Surg Date: 2013-02-21 Impact factor: 6.113
Authors: Kheng Choon Lim; Vivian W Wang; Fahad J Siddiqui; Luming Shi; Edwin S Y Chan; Hong Choon Oh; Say Beng Tan; Pierce K H Chow Journal: Hepatology Date: 2014-05-29 Impact factor: 17.425
Authors: A de Gramont; J F Bosset; C Milan; P Rougier; O Bouché; P L Etienne; F Morvan; C Louvet; T Guillot; E François; L Bedenne Journal: J Clin Oncol Date: 1997-02 Impact factor: 44.544
Authors: Skye C Mayo; Jennifer E Heckman; Andrew D Shore; Hari Nathan; Alexander A Parikh; John F P Bridges; Robert A Anders; Daniel A Anaya; Natasha S Becker; Timothy M Pawlik Journal: Surgery Date: 2011-08 Impact factor: 3.982
Authors: Rebecca C Auer; Rebekah R White; Nancy E Kemeny; Lawrence H Schwartz; Jinru Shia; Leslie H Blumgart; Ronald P Dematteo; Yuman Fong; William R Jarnagin; Michael I D'Angelica Journal: Cancer Date: 2010-03-15 Impact factor: 6.860
Authors: Axel Andres; Christian Toso; Rene Adam; Eduardo Barroso; Catherine Hubert; Lorenzo Capussotti; Eric Gerstel; Arnaud Roth; Pietro E Majno; Gilles Mentha Journal: Ann Surg Date: 2012-11 Impact factor: 12.969