title: Hepatic Resection for Disappearing Liver Metastasis: a Cost-Utility Analysis.
abstract: BACKGROUND
  We sought to estimate the cost-effectiveness of hepatic resection (HR) (strategy A) relative to surveillance plus 6 months of additional systemic chemotherapy (sCT) (strategy B) for patients with colorectal disappearing liver metastases (DLM).
  
  
  METHODS
  A Markov model was developed using data from a systematic literature review. Three base cases were evaluated: (1) a 60-year-old patient with three lesions in the right hemi-liver who underwent 6 months of sCT, had normalized carcinoembryonic antigen (CEA), and was diagnosed with DLM through a computed tomography (CT) scan; (2) a 60-year-old patient with three lesions in the right hemi-liver who underwent 6 months of sCT, had normalized CEA, and was diagnosed with DLM through a magnetic resonance imaging (MRI) scan; and (3) a 60-year-old patient with three lesions in the right hemi-liver who underwent 6 months of sCT plus hepatic artery infusion (HAI), had normalized CEA, and was diagnosed with DLM through a MRI scan. The outcomes evaluated were quality-adjusted life months (QALMs), incremental cost-effectiveness ratio (ICER), and net health benefit (NHB).
  
  
  RESULTS
  The NHB of strategy A versus strategy B was positive in base case 1 (7.7 QALMs, ICER $34.449/quality-adjusted life year (QALY)) and base case 2 (1.6 QALMs, ICER $43,948/QALY). In contrast it was negative (-0.2 QALMs, ICER $72,474/QALY) for base case 3. Monte Carlo simulation showed that strategy B is acceptable only in old patients (>60 years) with normalized CEA and MRI-based diagnosis. In younger patients, strategy B may reach cost-effectiveness only after sCT plus HAI.
  
  
  CONCLUSIONS
  Surveillance of DLM after sCT was more beneficial and cost-effective among patients >60 years with multiple factors predictive of true complete pathological response, such as normalization of CEA, HAI therapy, BMI ≤30 kg/m(2), and diagnosis of DLM made through MRI.
authors.affiliation: Department of Surgery, Division of Surgical Oncology, The Johns Hopkins Hospital, 600 N. Wolfe Street, Blalock 688, Baltimore, MD, 21287, USA.
authors.forename: Gaya
authors.initials: G
authors.lastname: Spolverato
authors.forename: Alessandro
authors.initials: A
authors.lastname: Vitale
authors.forename: Aslam
authors.initials: A
authors.lastname: Ejaz
authors.forename: David
authors.initials: D
authors.lastname: Cosgrove
authors.forename: Darren
authors.initials: D
authors.lastname: Cowzer
authors.forename: Umberto
authors.initials: U
authors.lastname: Cillo
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Pawlik
mesh_terms: D000970:Antineoplastic Agents / Q000191:economics / Q000627:therapeutic use; D015179:Colorectal Neoplasms / Q000473:pathology*; D003362:Cost-Benefit Analysis; D005260:Female; D006498:Hepatectomy / Q000191:economics*; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary* / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D014057:Tomography, X-Ray Computed
chemical_list: D000970:Antineoplastic Agents