Cost-utility analysis of operative versus non-operative treatment for colorectal liver metastases. Br J Surg 2015 Mar;102(4):388-98
Date
01/28/2015Pubmed ID
25624168DOI
10.1002/bjs.9761Scopus ID
2-s2.0-84923117454 (requires institutional sign-in at Scopus site) 12 CitationsAbstract
BACKGROUND: Surgical resection of colorectal liver metastases (CRLMs) is the standard of care when possible, although this strategy has not been compared with non-operative interventions in controlled trials. Although survival outcomes are clear, the cost-effectiveness of surgery is not. This study aimed to estimate the cost-effectiveness of resection for CRLMs compared with non-operative treatment (palliative care including chemotherapy).
METHODS: Operative and non-operative cohorts were identified from a prospectively maintained database. Patients in the operative cohort had a minimum of 10 years of follow-up. A model-based cost-utility analysis was conducted to quantify the mean cost and quality-adjusted life-years (QALYs) over a lifetime time horizon. The analysis was conducted from a healthcare provider perspective (UK National Health Service) in a secondary care (hospital) setting.
RESULTS: Median survival was 41 and 21 months in the operative and non-operative cohorts respectively (P < 0·001). The operative strategy dominated non-operative treatments, being less costly (€22,200 versus €32,800) and more effective (4·017 versus 1·111 QALYs gained). The results of extensive sensitivity analysis showed that the operative strategy dominated non-operative treatment in every scenario.
CONCLUSION: Operative treatment of CRLMs yields greater survival than non-operative treatment, and is both more effective and less costly.
Author List
Roberts KJ, Sutton AJ, Prasad KR, Toogood GJ, Lodge JPAuthor
Kondragunta Rajendra Prasad MBBS Professor in the Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AgedAntineoplastic Combined Chemotherapy Protocols
Colorectal Neoplasms
Female
Humans
Liver Neoplasms
Male
Markov Chains
Metastasectomy
Middle Aged
Palliative Care
Prospective Studies
Quality-Adjusted Life Years
Survival Analysis
Treatment Outcome
