To analyze the cost-effectiveness of resection for liver metastases compared with standard nonsurgical cytotoxic treatment.
The efficacy of hepatic resection for metastases from colorectal cancer has been debated, despite reported 5-year survival rates of 20% to 40%. Resection is confined to specialized centers and is not widely available, perhaps because of lack of appropriate expertise, resources, or awareness of its efficacy. The cost-effectiveness of resection is important from the perspective of managed care in the United States and for the commissioning of health services in the United Kingdom.
A simple decision-based model was developed to evaluate the marginal costs and health benefits of hepatic resection. Estimates of resectability for liver metastases were taken from UK-reported case series data. The results of 100 hepatic resections conducted in Sheffield from 1997 to 1999 were used for the cost calculation of liver resection. Survival data from published series of resections were compiled to estimate the incremental cost per life-year gained (LYG) because of the short period of follow-up in the Sheffield series.
Hepatic resection for colorectal liver metastases provides an estimated marginal benefit of 1.6 life-years (undiscounted) at a marginal cost of £6,742. If 17% of patients have only palliative resections, the overall cost per LYG is approximately £5,236 (£5,985 with discounted benefits). If potential benefits are extended to include 20-year survival rates, these figures fall to approximately £1,821 (£2,793 with discounted benefits). Further univariate sensitivity analysis of key model parameters showed the cost per LYG to be consistently less than £15,000.
In this model, hepatic resection appears highly cost-effective compared with nonsurgical treatments for colorectal-related liver metastases.
From the *School of Health and Related Research, the †Department of Public Health, Sheffield Health Authority, and the ‡Department of Surgical and Anaesthetic Sciences, University of Sheffield, Sheffield, United Kingdom
Correspondence: Stephen M. Beard, MSc, School of Health and Related Research, University of Sheffield, Sheffield S1 4DA, United Kingdom.
Presented at the Seventh Annual Meeting of the European Surgical Association, Amstel Intercontinental Hotel, Amsterdam, The Netherlands, April 14–15, 2000.
Funded as part of the Trent Working Group for Acute Purchasing, a U.K. National Health Service Executive evidence-based review group, now providing input into the newly formed National Institute for Clinical Excellence.
Accepted for publication July 2000.