Cost‐effectiveness of simultaneous resection and RFA versus 2‐stage hepatectomy for bilobar colorectal liver metastases. Issue 6 (23rd December 2013)

• Record Type: Journal Article
• Authors: Abbott, Daniel E.; Sohn, Vance Y.; Hanseman, Dennis; Curley, Steven A.
• Is Part Of: Journal of surgical oncology. Volume 109:Issue 6(2014:May 01)
• Page Start: 516
• Page End: 520
• Publication Date: 2013-12-23
• Subjects: Cancer -- Surgery -- Periodicals; Neoplasms -- Periodicals; 616
• DOI: 10.1002/jso.23539
• Languages: English
• ISSNs: 0022-4790

Abstract

<abstract abstract-type="main" xml:lang="en"> <title>Abstract</title> <sec id="jso23539-sec-0001" sec-type="section"> <title>Background and Objectives</title> <p>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).</p> </sec> <sec id="jso23539-sec-0002" sec-type="section"> <title>Methods</title> <p>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$).</p> </sec> <sec id="jso23539-sec-0003" sec-type="section"> <title>Results</title> <p>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.</p> </sec> <sec id="jso23539-sec-0004" sec-type="section"> <title>Conclusions</title> <p>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. <italic>J. Surg. Oncol. 2014 109:???–???</italic>. © 2013 Wiley Periodicals, Inc.</p> </sec> </abstract>