title: Cost-effectiveness of simultaneous resection and RFA versus 2-stage hepatectomy for bilobar colorectal liver metastases.
abstract: OBJECTIVE
  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).
  
  
  METHODS
  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$).
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Surgery, University of Cincinnati, Cincinnati, Ohio.
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Abbott
authors.forename: Vance Y
authors.initials: VY
authors.lastname: Sohn
authors.forename: Dennis
authors.initials: D
authors.lastname: Hanseman
authors.forename: Steven A
authors.initials: SA
authors.lastname: Curley
mesh_terms: D000368:Aged; D017115:Catheter Ablation / Q000191:economics*; D017024:Chemotherapy, Adjuvant; D015179:Colorectal Neoplasms / Q000473:pathology*; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D004621:Embolization, Therapeutic; D005260:Female; D006498:Hepatectomy / Q000191:economics* / Q000379:methods; D006801:Humans; D008113:Liver Neoplasms / Q000191:economics / Q000401:mortality* / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011169:Portal Vein; D012189:Retrospective Studies; D018084:Ultrasonography, Interventional
keywords: comparative effectiveness; liver surgery; resource utilization