PMID- 25999251
OWN - NLM
STAT- MEDLINE
DCOM- 20150914
LR  - 20220408
IS  - 1532-7361 (Electronic)
IS  - 0039-6060 (Linking)
VI  - 158
IP  - 2
DP  - 2015 Aug
TI  - Net health benefit of hepatic resection versus intraarterial therapies for 
      neuroendocrine liver metastases: A Markov decision model.
PG  - 339-48
LID - S0039-6060(15)00237-8 [pii]
LID - 10.1016/j.surg.2015.03.033 [doi]
AB  - BACKGROUND: Management of patients with neuroendocrine liver metastasis (NELM) 
      remains controversial. We sought to compare the net health benefit (NHB) of 
      hepatic resection (HR) versus intraarterial therapy (IAT) among patients with 
      NELM. METHODS: A decision analytic Markov model was created to estimate and 
      compare the cost effectiveness associated with different management strategies 
      (HR vs IAT) for a simulated cohort of patients with NELM. The primary (base case) 
      analysis was calculated based on a 57-year-old male patient with metachronous, 
      symptomatic NELM that involved <25% of the liver in the absence of extrahepatic 
      disease. The endpoints were quality-adjusted life-months (QALMs), 
      quality-adjusted life-year (QALY), incremental cost-effectiveness ratio (ICER), 
      and NHB. RESULTS: In the base case analysis, HR was strongly favored over IAT 
      providing NHB of 20.0 QALMs and an ICER of $8,427 per QALY. In the Monte Carlo 
      simulation, the greatest NHB for HR was among patients with 
      functioning/symptomatic NELM, regardless of liver tumor burden. In the 
      symptomatic group, IAT was favored only in a minority of old patients (>60 years) 
      with extrahepatic disease and synchronous NELM. In contrast, in patients with 
      nonfunctioning/asymptomatic NELM, hepatic tumor burden was the most important 
      variable and HR was always cost ineffective in large tumors, independent of 
      patient age and extrahepatic disease characteristics. CONCLUSION: A Markov 
      decision model demonstrated that HR was the preferred strategy among patients 
      with symptomatic NELM, regardless of hepatic disease burden. In contrast, IAT 
      should be preferred for patients with large volume nonfunctioning/asymptomatic 
      NELM.
CI  - Copyright (c) 2015 Elsevier Inc. All rights reserved.
FAU - Spolverato, Gaya
AU  - Spolverato G
AD  - Department of Surgery, The Johns Hopkins University School of Medicine, 
      Baltimore, MD.
FAU - Vitale, Alessandro
AU  - Vitale A
AD  - Unita di Chirurgia Epatobiliare e Trapianto Epatico, Azienda 
      Ospedaliera-Universita di Padova, Padova, Italy.
FAU - Ejaz, Aslam
AU  - Ejaz A
AD  - Department of Surgery, The Johns Hopkins University School of Medicine, 
      Baltimore, MD.
FAU - Kim, Yuhree
AU  - Kim Y
AD  - Department of Surgery, The Johns Hopkins University School of Medicine, 
      Baltimore, MD.
FAU - Cosgrove, David
AU  - Cosgrove D
AD  - Department of Medical Oncology, The Johns Hopkins University School of Medicine, 
      Baltimore, MD.
FAU - Schlacter, Todd
AU  - Schlacter T
AD  - Department of Radiology, Interventional Radiology, The Johns Hopkins University 
      School of Medicine, Baltimore, MD.
FAU - Geschwind, Jean-Francis
AU  - Geschwind JF
AD  - Department of Radiology, Interventional Radiology, The Johns Hopkins University 
      School of Medicine, Baltimore, MD.
FAU - Pawlik, Timothy M
AU  - Pawlik TM
AD  - Department of Surgery, The Johns Hopkins University School of Medicine, 
      Baltimore, MD. Electronic address: tpawlik1@jhmi.edu.
LA  - eng
PT  - Comparative Study
PT  - Evaluation Study
PT  - Journal Article
DEP - 20150518
PL  - United States
TA  - Surgery
JT  - Surgery
JID - 0417347
SB  - IM
MH  - Computer Simulation
MH  - *Cost-Benefit Analysis
MH  - Decision Support Techniques
MH  - Health Care Costs
MH  - Hepatectomy/*economics/mortality
MH  - Humans
MH  - Infusions, Intra-Arterial/*economics/mortality
MH  - Liver Neoplasms/economics/mortality/*secondary/*therapy
MH  - Male
MH  - Markov Chains
MH  - Middle Aged
MH  - Models, Economic
MH  - Monte Carlo Method
MH  - Neuroendocrine Tumors/economics/mortality/*secondary/*therapy
MH  - Quality-Adjusted Life Years
MH  - Treatment Outcome
MH  - United States
EDAT- 2015/05/23 06:00
MHDA- 2015/09/15 06:00
CRDT- 2015/05/23 06:00
PHST- 2014/12/21 00:00 [received]
PHST- 2015/03/03 00:00 [revised]
PHST- 2015/03/04 00:00 [accepted]
PHST- 2015/05/23 06:00 [entrez]
PHST- 2015/05/23 06:00 [pubmed]
PHST- 2015/09/15 06:00 [medline]
AID - S0039-6060(15)00237-8 [pii]
AID - 10.1016/j.surg.2015.03.033 [doi]
PST - ppublish
SO  - Surgery. 2015 Aug;158(2):339-48. doi: 10.1016/j.surg.2015.03.033. Epub 2015 May 
      18.