Health Economic Evaluation of Patients With Colorectal Liver Metastases Randomized to ALPPS or TSH: Analysis From the LIGRO Trial
Objective:. This is a preplanned, health economic evaluation from the LIGRO trial. One hundred patients with colorectal liver metastases (CRLM) and standardized future liver remnant <30% were randomized to associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) or two-...
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Wolters Kluwer Health
2024-03-01
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| Series: | Annals of Surgery Open |
| Online Access: | http://journals.lww.com/10.1097/AS9.0000000000000367 |
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| author | Kristina Hasselgren, MD, PhD Martin Henriksson, PhD Bård I. Røsok, MD, PhD Peter N. Larsen, MD, PhD Ernesto Sparrelid, MD, PhD Gert Lindell, MD, PhD Nicolai A. Schultz, MD, PhD Bjorn A. Bjørnbeth, MD, PhD Bengt Isaksson, MD, PhD Magnus Rizell, MD, PhD Anna Lindhoff Larsson, RN Per Sandström, MD, PhD Bergthor Björnsson, MD, PhD |
| author_facet | Kristina Hasselgren, MD, PhD Martin Henriksson, PhD Bård I. Røsok, MD, PhD Peter N. Larsen, MD, PhD Ernesto Sparrelid, MD, PhD Gert Lindell, MD, PhD Nicolai A. Schultz, MD, PhD Bjorn A. Bjørnbeth, MD, PhD Bengt Isaksson, MD, PhD Magnus Rizell, MD, PhD Anna Lindhoff Larsson, RN Per Sandström, MD, PhD Bergthor Björnsson, MD, PhD |
| author_sort | Kristina Hasselgren, MD, PhD |
| collection | DOAJ |
| description | Objective:. This is a preplanned, health economic evaluation from the LIGRO trial. One hundred patients with colorectal liver metastases (CRLM) and standardized future liver remnant <30% were randomized to associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) or two-staged hepatectomy (TSH).
Summary Background Data:. TSH, is an established method in advanced CRLM. ALPPS has emerged providing improved resection rate and survival. The health care costs and health outcomes, combining health-related quality of life (HRQoL) and survival into quality-adjusted life years (QALYs), of ALPPS and TSH have not previously been evaluated and compared.
Methods:. Costs and QALYs were compared from treatment start up to 2 years. Costs are estimated from resource use, including all surgical interventions, length of stay after interventions, diagnostic procedures and chemotherapy, and applying Swedish unit costs. QALYs were estimated by combining survival and HRQoL data, the latter being assessed with EQ-5D 3L. Estimated costs and QALYs for each treatment strategy were combined into an incremental cost-effectiveness ratio (ICER). Nonparametric bootstrapping was used to assess the joint distribution of incremental costs and QALYs.
Results:. The mean cost difference between ALPPS and TSH was 12,662€, [95% confidence interval (CI): −10,728–36,051; P = 0.283]. Corresponding mean difference in life years and QALYs was 0.1296 (95% CI: −0.12–0.38; P = 0.314) and 0.1285 (95% CI: −0.11–0.36; P = 0.28), respectively. The ICER was 93,186 and 92,414 for QALYs and life years as outcomes, respectively.
Conclusions:. Based on the 2-year data, the cost-effectiveness of ALPPS is uncertain. Further research, exploring cost and health outcomes beyond 2 years is needed. |
| format | Article |
| id | doaj-art-c49d9c97684a4ced87c21e07b1c84c50 |
| institution | Kabale University |
| issn | 2691-3593 |
| language | English |
| publishDate | 2024-03-01 |
| publisher | Wolters Kluwer Health |
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| series | Annals of Surgery Open |
| spelling | doaj-art-c49d9c97684a4ced87c21e07b1c84c502025-01-24T09:18:25ZengWolters Kluwer HealthAnnals of Surgery Open2691-35932024-03-0151e36710.1097/AS9.0000000000000367202403000-00026Health Economic Evaluation of Patients With Colorectal Liver Metastases Randomized to ALPPS or TSH: Analysis From the LIGRO TrialKristina Hasselgren, MD, PhD0Martin Henriksson, PhD1Bård I. Røsok, MD, PhD2Peter N. Larsen, MD, PhD3Ernesto Sparrelid, MD, PhD4Gert Lindell, MD, PhD5Nicolai A. Schultz, MD, PhD6Bjorn A. Bjørnbeth, MD, PhD7Bengt Isaksson, MD, PhD8Magnus Rizell, MD, PhD9Anna Lindhoff Larsson, RN10Per Sandström, MD, PhD11Bergthor Björnsson, MD, PhD12* From the Division of surgery, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden† Centre for Medical Technology Assessment, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden‡ Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway§ Department of Surgical Gastroenterology and Transplantation, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark‖ Department of Clinical Science, Intervention and Technology, Division of Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden¶ Department of Surgery, Skane University Hospital, Lund, Sweden§ Department of Surgical Gastroenterology and Transplantation, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark‡ Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway# Department of Surgery, Akademiska University Hospital, Uppsala, Sweden** Department of Transplantation and Liver Surgery, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.* From the Division of surgery, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden* From the Division of surgery, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden* From the Division of surgery, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, SwedenObjective:. This is a preplanned, health economic evaluation from the LIGRO trial. One hundred patients with colorectal liver metastases (CRLM) and standardized future liver remnant <30% were randomized to associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) or two-staged hepatectomy (TSH). Summary Background Data:. TSH, is an established method in advanced CRLM. ALPPS has emerged providing improved resection rate and survival. The health care costs and health outcomes, combining health-related quality of life (HRQoL) and survival into quality-adjusted life years (QALYs), of ALPPS and TSH have not previously been evaluated and compared. Methods:. Costs and QALYs were compared from treatment start up to 2 years. Costs are estimated from resource use, including all surgical interventions, length of stay after interventions, diagnostic procedures and chemotherapy, and applying Swedish unit costs. QALYs were estimated by combining survival and HRQoL data, the latter being assessed with EQ-5D 3L. Estimated costs and QALYs for each treatment strategy were combined into an incremental cost-effectiveness ratio (ICER). Nonparametric bootstrapping was used to assess the joint distribution of incremental costs and QALYs. Results:. The mean cost difference between ALPPS and TSH was 12,662€, [95% confidence interval (CI): −10,728–36,051; P = 0.283]. Corresponding mean difference in life years and QALYs was 0.1296 (95% CI: −0.12–0.38; P = 0.314) and 0.1285 (95% CI: −0.11–0.36; P = 0.28), respectively. The ICER was 93,186 and 92,414 for QALYs and life years as outcomes, respectively. Conclusions:. Based on the 2-year data, the cost-effectiveness of ALPPS is uncertain. Further research, exploring cost and health outcomes beyond 2 years is needed.http://journals.lww.com/10.1097/AS9.0000000000000367 |
| spellingShingle | Kristina Hasselgren, MD, PhD Martin Henriksson, PhD Bård I. Røsok, MD, PhD Peter N. Larsen, MD, PhD Ernesto Sparrelid, MD, PhD Gert Lindell, MD, PhD Nicolai A. Schultz, MD, PhD Bjorn A. Bjørnbeth, MD, PhD Bengt Isaksson, MD, PhD Magnus Rizell, MD, PhD Anna Lindhoff Larsson, RN Per Sandström, MD, PhD Bergthor Björnsson, MD, PhD Health Economic Evaluation of Patients With Colorectal Liver Metastases Randomized to ALPPS or TSH: Analysis From the LIGRO Trial Annals of Surgery Open |
| title | Health Economic Evaluation of Patients With Colorectal Liver Metastases Randomized to ALPPS or TSH: Analysis From the LIGRO Trial |
| title_full | Health Economic Evaluation of Patients With Colorectal Liver Metastases Randomized to ALPPS or TSH: Analysis From the LIGRO Trial |
| title_fullStr | Health Economic Evaluation of Patients With Colorectal Liver Metastases Randomized to ALPPS or TSH: Analysis From the LIGRO Trial |
| title_full_unstemmed | Health Economic Evaluation of Patients With Colorectal Liver Metastases Randomized to ALPPS or TSH: Analysis From the LIGRO Trial |
| title_short | Health Economic Evaluation of Patients With Colorectal Liver Metastases Randomized to ALPPS or TSH: Analysis From the LIGRO Trial |
| title_sort | health economic evaluation of patients with colorectal liver metastases randomized to alpps or tsh analysis from the ligro trial |
| url | http://journals.lww.com/10.1097/AS9.0000000000000367 |
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