Costs and efficiency of a tumor follow-up program for the detection of colorectal liver metastases.
From January 1987 until July 1999 we admitted 1003 patients with colorectal cancer and 31 with resected colorectal liver metastases to our tumor follow-up program. After R0 resection of the primary tumor 60 patients developed liver metastases during the postoperative follow-up. R0 resection of the metastases was performed in 16 of these cases without lethality and low morbidity. In the further course of the follow-up 8 of these patients again developed liver metastases, two of whom underwent reoperation. The overall 5-year survival rate after R0 resection of liver metastases was 20%. In 726 patients we performed 3719 follow-up examinations. Following the German regulations on physicians' fees for follow-up-examinations we calculated the cost of detecting a liver metastasis to be DM 16,500 per patient. Mean costs were DM 62,000 in patients in whom the metastases were successfully resected. The results of this study show that although the costs are very high for patients who benefit from the follow-up program, 26.7% of those with liver metastases are detected in such an early stage, and that an R0 resection can be performed. This study shows that the high costs of tumor follow-up programs for detecting liver metastases in patients with resected colorectal cancer can be justified by the good outcome of patients in whom an early diagnosis of recurrent disease is made.
Ketteniss
M
M
Department of Surgery, Kliniken der Landeshauptstadt Düsseldorf, Krankenhaus Gerresheim, Gräulingerstrasse 120, 40625 Düsseldorf, Germany.
Schütz
G
G
Ulrich
B
B
D000230:Adenocarcinoma / Q000191:economics / Q000401:mortality / Q000556:secondary* / Q000601:surgery; D000328:Adult; D000368:Aged; D015179:Colorectal Neoplasms / Q000191:economics* / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D003365:Costs and Cost Analysis; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D017048:Health Care Costs; D006801:Humans; D008113:Liver Neoplasms / Q000191:economics / Q000401:mortality / Q000556:secondary* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000191:economics; D009367:Neoplasm Staging; D010166:Palliative Care / Q000191:economics; D005791:Patient Care / Q000191:economics*; D015397:Program Evaluation; D012042:Registries; D016019:Survival Analysis