title: Cost-utility analysis of operative versus non-operative treatment for colorectal liver metastases.
abstract: BACKGROUND
  Surgical resection of colorectal liver metastases (CRLMs) is the standard of care when possible, although this strategy has not been compared with non-operative interventions in controlled trials. Although survival outcomes are clear, the cost-effectiveness of surgery is not. This study aimed to estimate the cost-effectiveness of resection for CRLMs compared with non-operative treatment (palliative care including chemotherapy).
  
  
  METHODS
  Operative and non-operative cohorts were identified from a prospectively maintained database. Patients in the operative cohort had a minimum of 10 years of follow-up. A model-based cost-utility analysis was conducted to quantify the mean cost and quality-adjusted life-years (QALYs) over a lifetime time horizon. The analysis was conducted from a healthcare provider perspective (UK National Health Service) in a secondary care (hospital) setting.
  
  
  RESULTS
  Median survival was 41 and 21 months in the operative and non-operative cohorts respectively (P < 0·001). The operative strategy dominated non-operative treatments, being less costly (€22,200 versus €32,800) and more effective (4·017 versus 1·111 QALYs gained). The results of extensive sensitivity analysis showed that the operative strategy dominated non-operative treatment in every scenario.
  
  
  CONCLUSIONS
  Operative treatment of CRLMs yields greater survival than non-operative treatment, and is both more effective and less costly.
authors.affiliation: Department of Hepatobiliary and Pancreatic Surgery, University Hospitals Birmingham, Leeds, UK.
authors.forename: K J
authors.initials: KJ
authors.lastname: Roberts
authors.forename: A J
authors.initials: AJ
authors.lastname: Sutton
authors.forename: K R
authors.initials: KR
authors.lastname: Prasad
authors.forename: G J
authors.initials: GJ
authors.lastname: Toogood
authors.forename: J P A
authors.initials: JP
authors.lastname: Lodge
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000191:economics / Q000627:therapeutic use; D015179:Colorectal Neoplasms; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000191:economics* / Q000556:secondary / Q000628:therapy; D008297:Male; D008390:Markov Chains; D059146:Metastasectomy / Q000191:economics; D008875:Middle Aged; D010166:Palliative Care / Q000191:economics; D011446:Prospective Studies; D019057:Quality-Adjusted Life Years; D016019:Survival Analysis; D016896:Treatment Outcome