Economic model of observation versus immediate resection of hepatic adenomas. J Surg Oncol 2012 Sep 15;106(4):491-7
Date
03/24/2012Pubmed ID
22442008DOI
10.1002/jso.23099Scopus ID
2-s2.0-84865129149 (requires institutional sign-in at Scopus site)Abstract
BACKGROUND AND OBJECTIVES: For small asymptomatic hepatic adenomas (HA), available data are insufficient to establish the superiority of either observation or surgery. We sought to investigate the cost-effectiveness of two initial management strategies.
METHODS: We performed a comparative analysis of two theoretical cohorts of 100 patients with small (<5 cm), asymptomatic HA. Discounted cash flow (DCF) models compared the net present value (NPV) of both treatment options at year 10 under three distinct progression rate scenarios. A break-even (BE) analysis was used to determine the BE point at which the NPV for observation and immediate surgery intersect.
RESULTS: The NPV for immediate surgery was $1,733,955. The NPV for observation varied between $2,065,315-$2,745,631 for computed tomography (CT), $2,264,575-$2,929,541 for magnetic resonance imaging (MRI), and $802,837-$1,580,413 for ultrasound (US). The BE point was between 6 and 8 years for CT and 5-7 years for MRI. The BE point for US was not reached except in the highest progression rate scenario (12 years).
CONCLUSIONS: This study highlights the importance of the underlying progression rate and the cost of imaging when following patients with asymptomatic HA. Overall, US surveillance is the most cost-efficient approach to observing small asymptomatic HA. If cross-sectional imaging is utilized, then immediate surgery is the most cost-effective decision at 5-8 years.
Author List
Vanounou T, Groeschl RT, Geller DA, Marsh JW, Gamblin TCAuthor
Thomas Clark Gamblin MD Professor in the Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
Carcinoma, HepatocellularCohort Studies
Health Care Costs
Humans
Liver Neoplasms
Magnetic Resonance Imaging
Models, Economic
Tomography, X-Ray Computed
