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Jodidio M, Panse NS, Prasath V, Trivedi R, Arjani S, Chokshi RJ. Cost-effectiveness of staging laparoscopy with peritoneal cytology in pancreatic adenocarcinoma. Curr Probl Surg 2024; 61:101442. [PMID: 38462312 DOI: 10.1016/j.cpsurg.2024.101442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 01/09/2024] [Indexed: 03/12/2024]
Affiliation(s)
- Maya Jodidio
- Division of Surgical Oncology, Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ
| | - Neal S Panse
- Division of Surgical Oncology, Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ
| | - Vishnu Prasath
- Rutgers New Jersey Medical School, Newark, NJ; Department of Medicine, The Ohio State University College of Medicine, Columbus, OH
| | | | | | - Ravi J Chokshi
- Division of Surgical Oncology, Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ.
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Prasath V, Quinn PL, Oliver JB, Arjani S, Ahlawat SK, Chokshi RJ. Cost-effectiveness analysis of infected necrotizing pancreatitis management in an academic setting. Pancreatology 2022; 22:185-193. [PMID: 34879998 DOI: 10.1016/j.pan.2021.11.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 11/22/2021] [Accepted: 11/30/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Traditional management for infected necrotizing pancreatitis (INP) often utilizes open necrosectomy, which carries high morbidity and complication rates. Thus, minimally invasive strategies have gained favor, specifically step-up approaches utilizing endoscopic or minimally-invasive surgery (MIS); however, the ideal management modality for INP has not been identified. METHODS A decision tree model was designed to analyze costs and survival associated with open necrosectomy, endoscopic step-up, and MIS step-up protocols for management of INP after 4 weeks of necrosis development with adequate retroperitoneal access. Costs were based on a third-party payer perspective using Medicare reimbursement rates. The model's effectiveness was represented by quality-adjusted life-years (QALYs). Sensitivity analyses were performed to validate results. RESULTS Endoscopic step-up was the dominant economic strategy with 7.92 QALYs for $90,864.09. Surgical step-up resulted in a decrease of 0.09 QALYs and a cost increase of $10,067.89 while open necrosectomy resulted in a decrease of 0.4 QALYs and an increased cost of $18,407.52 over endoscopic step-up. In 100,000 random-sampling simulations, 65.5% of simulations favored endoscopic step-up. MIS step-up was favored when MIS acute mortality rates fell and when MIS drainage success rates rose. CONCLUSIONS In our simulated patients with INP, the most cost-effective management strategy is endoscopic step-up. Cost-effectiveness varies with changes in acute mortality and drainage success, which will depend on local expertise.
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Affiliation(s)
- Vishnu Prasath
- Division of Surgical Oncology, Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA.
| | - Patrick L Quinn
- Division of Surgical Oncology, Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA.
| | - Joseph B Oliver
- Division of Minimally Invasive Surgery, Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA.
| | - Simran Arjani
- Division of Surgical Oncology, Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA.
| | - Sushil K Ahlawat
- Division of Gastroenterology and Hepatology, Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA.
| | - Ravi J Chokshi
- Division of Surgical Oncology, Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA.
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A comparison of the oxidative stress response in single-incision laparoscopic versus multi-trocar laparoscopic totally extraperitoneal inguinal hernia repair. Wideochir Inne Tech Maloinwazyjne 2020; 15:567-573. [PMID: 33294071 PMCID: PMC7687664 DOI: 10.5114/wiitm.2020.93202] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 01/13/2020] [Indexed: 01/07/2023] Open
Abstract
Introduction Surgical treatment is always associated with tissue damage and the subsequent development of oxidative stress. Aim To compare the oxidative stress response in patients treated operatively for inguinal hernia with multi-trocar laparoscopic totally extraperitoneal technique (TEP) or single-incision laparoscopic totally extraperitoneal technique (TEP-SI). Material and methods A randomized group of 34 patients with one-sided inguinal hernia was enrolled in the study. Seventeen patients were treated with a standard TEP method (group 1) and the other 17 patients were treated with the TEP-SI technique (group 2). Thiobarbituric acid reactive substances (TBARS) and total antioxidant status (TAS) as the oxidative stress markers were measured before surgery (0), 1 day (1) and 4 days (2) after surgery. Results A decrease in TAS on the first day after surgery was observed in both groups. Sustained reduction on the fourth day after surgery was observed in group 1, whereas in group 2 an increase followed. A statistically significant difference was observed in TAS (2 : 0) ratio with a meaningful decrease in group 1. TBARS concentration was elevated 1 day after surgery in both groups. It remained at an elevated level on the fourth day after surgery in group 1, while it decreased in group 2. The duration of surgery was higher in group 2 (mean: 57.5 min) than in group 1 (mean: 50.0 min) (p = 0.0286). Conclusions Oxidative stress levels are lower in patients treated operatively by TEP-SI technique than by TEP. TEP-SI may be considered as a less invasive technique associated with less tissue injury.
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Thiels CA, Ikoma N, Fournier K, Das P, Blum M, Estrella JS, Minsky BD, Ajani J, Mansfield P, Badgwell BD. Repeat staging laparoscopy for gastric cancer after preoperative therapy. J Surg Oncol 2018; 118:61-67. [PMID: 29878364 DOI: 10.1002/jso.25094] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Accepted: 04/16/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND OBJECTIVES Staging laparoscopy is recommended before preoperative therapy in patients with locoregional gastric cancer, but yield of repeated diagnostic laparoscopy at the time of resection is unknown. METHODS Retrospective review of a prospective database of patients with gastric adenocarcinoma (1994-2016) who had negative staging laparoscopy followed by preoperative therapy and subsequent attempted resection. Primary outcome was positive exploration (peritoneal or unresectable disease) at the time of resection. Multivariable logistic regression identified factors associated with positive exploration. RESULTS Of the 451 patients with attempted resection, 54 (12.0%) had positive explorations, including 48 with peritoneal disease. Patients with positive explorations were more likely to be female and have poorly differentiated tumors, linitis features, and signet-ring morphology. There was no significant difference by exploration results in age, race, clinical stage, or delayed definitive surgery. Positive explorations were independently associated with poor differentiation (OR 4.6, 95%CI 1.4-15.3; P = 0.01) and linitis (OR 4.2, 95%CI 1.9-9.2; P < 0.001). Positive explorations were seen in 14.0% of patients with poor differentiation, 36.6% of patients with linitis, and 5.8% of patients with neither linitis nor poor differentiation. CONCLUSION Despite negative pretreatment laparoscopy, post-treatment repeat laparoscopy may prevent non-therapeutic laparotomies. At a minimum, we recommend selective repeat laparoscopy for patients with linitis features.
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Affiliation(s)
| | - Naruhiko Ikoma
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Keith Fournier
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Prajnan Das
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mariela Blum
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jeannelyn S Estrella
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Bruce D Minsky
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jaffer Ajani
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Paul Mansfield
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Brian D Badgwell
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Sell NM, Fong ZV, del Castillo CF, Qadan M, Warshaw AL, Chang D, Lillemoe KD, Ferrone CR. Staging Laparoscopy Not Only Saves Patients an Incision, But May Also Help Them Live Longer. Ann Surg Oncol 2018; 25:1009-1016. [DOI: 10.1245/s10434-017-6317-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Indexed: 12/15/2022]
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Li K, Cannon JG, Jiang SY, Sambare TD, Owens DK, Bendavid E, Poultsides GA. Diagnostic staging laparoscopy in gastric cancer treatment: A cost-effectiveness analysis. J Surg Oncol 2017; 117:1288-1296. [DOI: 10.1002/jso.24942] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 11/07/2017] [Indexed: 12/23/2022]
Affiliation(s)
- Kevin Li
- Stanford University School of Medicine; Li Ka Shing Center; Stanford California
| | - John G.D. Cannon
- Stanford University School of Medicine; Li Ka Shing Center; Stanford California
| | - Sam Y. Jiang
- Stanford University School of Medicine; Li Ka Shing Center; Stanford California
| | - Tanmaya D. Sambare
- Stanford University School of Medicine; Li Ka Shing Center; Stanford California
| | - Douglas K. Owens
- VA Palo Alto Health Care System; Palo Alto California
- Center for Health Policy and the Center for Primary Care and Outcomes Research; Stanford University; Stanford California
| | - Eran Bendavid
- Center for Health Policy and the Center for Primary Care and Outcomes Research; Stanford University; Stanford California
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Goldstein DA, Zeichner SB, Bartnik CM, Neustadter E, Flowers CR. Metastatic Colorectal Cancer: A Systematic Review of the Value of Current Therapies. Clin Colorectal Cancer 2015; 15:1-6. [PMID: 26541320 DOI: 10.1016/j.clcc.2015.10.002] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 10/01/2015] [Accepted: 10/05/2015] [Indexed: 12/12/2022]
Abstract
To evaluate, from a US payer perspective, the cost-effectiveness of treatment strategies for metastatic colorectal cancer (mCRC), we performed a systematic review of published cost-effectiveness analyses. We identified 14 papers that fulfilled our search criteria and revealed varying levels of value among current treatment strategies. Older agents such as 5-fluorouracil, irinotecan, and oxaliplatin provide high-value treatments. More modern agents targeting the EGFR or VEGF pathways, such as bevacizumab, cetuximab, and panitumumab, do not appear to be cost-effective treatments at their current costs. The analytical methods used within the papers varied widely, and this variation likely plays a significant role in the heterogeneity in incremental cost-effectiveness ratios. The cost-effectiveness of current treatment strategies for mCRC is highly variable. Drugs recently approved by the US Food and Drug Administration for mCRC are not cost-effective, and this is primarily driven by high drug costs.
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Affiliation(s)
- Daniel A Goldstein
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA.
| | - Simon B Zeichner
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | | | - Eli Neustadter
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Christopher R Flowers
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
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Morris S, Gurusamy KS, Sheringham J, Davidson BR. Cost-effectiveness of diagnostic laparoscopy for assessing resectability in pancreatic and periampullary cancer. BMC Gastroenterol 2015; 15:44. [PMID: 25888495 PMCID: PMC4394561 DOI: 10.1186/s12876-015-0270-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 03/20/2015] [Indexed: 12/15/2022] Open
Abstract
Background Surgical resection is the only curative treatment for pancreatic and periampullary cancer, but many patients undergo unnecessary laparotomy because tumours can be understaged by computerised tomography (CT). A recent Cochrane review found diagnostic laparoscopy can decrease unnecessary laparotomy. We compared the cost-effectiveness of diagnostic laparoscopy prior to laparotomy versus direct laparotomy in patients with pancreatic and periampullary cancer with resectable disease based on CT scanning. Method Model based cost-utility analysis estimating mean costs and quality-adjusted life years (QALYs) per patient from the perspective of the UK National Health Service. A decision tree model was constructed using probabilities, outcomes and cost data from published sources. One-way and probabilistic sensitivity analyses were undertaken. Results When laparotomy following diagnostic laparoscopy occurred in a subsequent admission, diagnostic laparoscopy incurred similar mean costs per patient to direct laparotomy (£7470 versus £7480); diagnostic laparoscopy costs (£995) were offset by avoiding unnecessary laparotomy costs. Diagnostic laparoscopy produced significantly more mean QALYs per patient than direct laparotomy (0.346 versus 0.337). Results were sensitive to the accuracy of diagnostic laparoscopy and the probability that disease was unresectable. Diagnostic laparoscopy had 63 to 66% probability of being cost-effective at a maximum willingness to pay for a QALY of £20 000 to £30 000. When laparotomy was undertaken in the same admission as diagnostic laparoscopy the mean cost per patient of diagnostic laparoscopy increased to £8224. Conclusions Diagnostic laparoscopy prior to laparotomy in patients with CT-resectable cancer appears to be cost-effective in pancreatic cancer (but not in periampullary cancer), when laparotomy following diagnostic laparoscopy occurs in a subsequent admission. Electronic supplementary material The online version of this article (doi:10.1186/s12876-015-0270-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Stephen Morris
- Department of Applied Health Research, University College London, Gower Street, 1-19 Torrington Place, London, WC1E 7HB, UK.
| | - Kurinchi S Gurusamy
- University College London Medical School, 9th Floor, Royal Free Hospital, Rowland Hill Street, London, UK.
| | - Jessica Sheringham
- Department of Applied Health Research, University College London, Gower Street, 1-19 Torrington Place, London, WC1E 7HB, UK.
| | - Brian R Davidson
- University College London Medical School, 9th Floor, Royal Free Hospital, Rowland Hill Street, London, UK.
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Suner A, Karakülah G, Dicle O, Sökmen S, Çelikoğlu C. CorRECTreatment: a web-based decision support tool for rectal cancer treatment that uses the analytic hierarchy process and decision tree. Appl Clin Inform 2015; 6:56-74. [PMID: 25848413 PMCID: PMC4377560 DOI: 10.4338/aci-2014-10-ra-0087] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 12/22/2014] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The selection of appropriate rectal cancer treatment is a complex multi-criteria decision making process, in which clinical decision support systems might be used to assist and enrich physicians' decision making. OBJECTIVE The objective of the study was to develop a web-based clinical decision support tool for physicians in the selection of potentially beneficial treatment options for patients with rectal cancer. METHODS The updated decision model contained 8 and 10 criteria in the first and second steps respectively. The decision support model, developed in our previous study by combining the Analytic Hierarchy Process (AHP) method which determines the priority of criteria and decision tree that formed using these priorities, was updated and applied to 388 patients data collected retrospectively. Later, a web-based decision support tool named corRECTreatment was developed. The compatibility of the treatment recommendations by the expert opinion and the decision support tool was examined for its consistency. Two surgeons were requested to recommend a treatment and an overall survival value for the treatment among 20 different cases that we selected and turned into a scenario among the most common and rare treatment options in the patient data set. RESULTS In the AHP analyses of the criteria, it was found that the matrices, generated for both decision steps, were consistent (consistency ratio<0.1). Depending on the decisions of experts, the consistency value for the most frequent cases was found to be 80% for the first decision step and 100% for the second decision step. Similarly, for rare cases consistency was 50% for the first decision step and 80% for the second decision step. CONCLUSIONS The decision model and corRECTreatment, developed by applying these on real patient data, are expected to provide potential users with decision support in rectal cancer treatment processes and facilitate them in making projections about treatment options.
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Affiliation(s)
- A. Suner
- Ege University, School of Medicine, Department of Biostatistics and Medical Informatics, Bornova-Izmir, 35040, Turkey
| | - G. Karakülah
- Neurobiology-Neurodegeneration and Repair Laboratory, National Eye Institute, National Institutes of Health, Bethesda, Maryland, 20892, USA
- Dokuz Eylül University, Health Sciences Institute, Department of Medical Informatics, Inciraltı-Izmir, 35340, Turkey
| | - O. Dicle
- Dokuz Eylül University, Health Sciences Institute, Department of Medical Informatics, Inciraltı-Izmir, 35340, Turkey
- Dokuz Eylül University, School of Medicine, Department of Radiology, Inciraltı-Izmir, 35340, Turkey
| | - S. Sökmen
- FACS, FASCRS, FASPSM Member from Dokuz Eylül University, School of Medicine, Department of General Surgery, Colorectal and Pelvic Surgery Unit, Inciraltı-Izmir, 35340, Turkey
| | - C.C. Çelikoğlu
- Dokuz Eylül University, Faculty of Science, Department of Statistics, Buca-Izmir, 35160, Turkey
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Morris S, Gurusamy KS, Sheringham J, Davidson BR. Cost-effectiveness of preoperative biliary drainage for obstructive jaundice in pancreatic and periampullary cancer. J Surg Res 2014; 193:202-9. [PMID: 25172090 PMCID: PMC4274324 DOI: 10.1016/j.jss.2014.07.060] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 07/14/2014] [Accepted: 07/23/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND A recent Cochrane Review found that preoperative biliary drainage (PBD) in patients with resectable pancreatic and periampullary cancer undergoing surgery for obstructive jaundice is associated with similar mortality but increased serious morbidity compared with no PBD. Despite this clinical evidence of its lack of effectiveness, PBD is still in use. We considered the economic implications of PBD versus direct surgery for obstructive jaundice in patients with pancreatic and periampullary cancer. MATERIALS AND METHODS Model-based cost-utility analysis estimating mean costs and quality-adjusted life years (QALYs) per patient from the perspective of the UK National Health Service over a 6-month time horizon. A decision tree model was constructed and populated with probabilities, outcomes, and cost data from published sources. One-way and probabilistic sensitivity analyses were undertaken. RESULTS PBD was more costly than direct surgery (mean cost per patient £10,775 [$15,616] versus £8221 [$11,914]) and produced fewer QALYs (mean QALYs per patient 0.337 versus 0.343). Not performing PBD would result in cost savings of approximately £2500 ($3623) per patient to the National Health Service. PBD had <10% probability of being cost-effective at a maximum willingness to pay for a QALY of £20,000 ($28,986) to £30,000 ($43,478). CONCLUSIONS There are significant cost savings to be gained by avoiding routine PBD in patients with resectable pancreatic and periampullary cancer where PBD is still routinely used in this context; this economic evidence should be used to support the clinical argument for a change in practice.
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Affiliation(s)
- Stephen Morris
- Department of Applied Health Research, University College London, London, UK
| | - Kurinchi S Gurusamy
- Research Department of General Surgery, Royal Free Hospital, University College London Medical School, London, UK
| | - Jessica Sheringham
- Department of Applied Health Research, University College London, London, UK.
| | - Brian R Davidson
- Research Department of General Surgery, Royal Free Hospital, University College London Medical School, London, UK
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Luo LX, Yu ZY, Bai YN. Laparoscopic Hepatectomy for Liver Metastases from Colorectal Cancer: A Meta-analysis. J Laparoendosc Adv Surg Tech A 2014; 24:213-22. [PMID: 24571350 DOI: 10.1089/lap.2013.0399] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- Li-Xi Luo
- Department of Hepatobiliary Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Zhao-Yan Yu
- Department of Hepatobiliary Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Yan-Nan Bai
- Department of Hepatobiliary Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
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Effectiveness and cost-effectiveness of peri-operative versus post-operative chemotherapy for resectable colorectal liver metastases. Eur J Cancer 2011; 47:2291-8. [PMID: 21652204 DOI: 10.1016/j.ejca.2011.05.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Revised: 05/05/2011] [Accepted: 05/10/2011] [Indexed: 12/12/2022]
Abstract
BACKGROUND The role of neo-adjuvant chemotherapy prior to hepatectomy in patients with resectable colorectal liver metastases is currently a matter of debate. The aim of the present study was to analyse life-expectancy, quality adjusted life-expectancy and cost-effectiveness of the two chemotherapeutic strategies. METHODS A Markov decision model was developed, on the basis of parameters derived from an extensive literature search of the last ten years, to compare outcomes of peri-operative versus post-operative chemotherapy. RESULTS Life-expectancy observed for peri-operative chemotherapy was 54.56months and 52.62months with post-operative chemotherapy only; the quality-adjusted life-expectancy with peri-operative chemotherapy was 39.33 quality-adjusted life-months (QALMs) and 37.84 QALMs with post-operative chemotherapy. Peri-operative chemotherapy results in an increase in total costs of 1180€ over ten years and in an incremental cost-effectiveness ratio (ICER) of 791.9€/QALM. The model was more sensitive to the expected 3-year recurrence-free survival (RFS) and cost of hepatic resection: with respect to an expected 3-year RFS⩽25% the peri-operative approach was more cost-effective than post-operative strategy but differences in average cost-effectiveness were small. The relationship between ICER and cost of hepatic resection was inverse because the higher the cost of hepatic resection, the higher the cost saving due to patients becoming unresectable during neo-adjuvant therapy. CONCLUSIONS In the treatment of resectable colorectal liver metastases, the addition of neo-adjuvant chemotherapy could be cost-effective because it makes it possible to avoid hepatic resection in patients who do not respond to the neo-adjuvant approach; however, the life-expectancy of the two strategies is very similar.
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Pessaux P, Panaro F. Advantages of the first-step totally laparoscopic approach in 2-staged hepatectomy for colorectal synchronous liver metastasis. Surgery 2009; 145:453. [PMID: 19303997 DOI: 10.1016/j.surg.2008.09.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2008] [Accepted: 09/29/2008] [Indexed: 12/12/2022]
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