PMID- 26148521
OWN - NLM
STAT- MEDLINE
DCOM- 20160427
LR  - 20181202
IS  - 1432-2323 (Electronic)
IS  - 0364-2313 (Linking)
VI  - 39
IP  - 10
DP  - 2015 Oct
TI  - Liver Resection for Advanced Intrahepatic Cholangiocarcinoma: A Cost-Utility 
      Analysis.
PG  - 2500-9
LID - 10.1007/s00268-015-3150-1 [doi]
AB  - BACKGROUND: Data on cost-effectiveness and efficacy of hepatic resection (HR) for 
      advanced intrahepatic cholangiocarcinoma (ICC) are lacking. We sought to estimate 
      the cost-effectiveness of upfront HR resulting in an R1 resection (strategy A) 
      relative to initial systemic chemotherapy (sCT) followed by possible curative HR 
      (strategy B) for patients with advanced ICC. METHODS: A Markov model was 
      developed using data from a systematic literature review. Three base cases were 
      considered: (1) ICC >6 cm (2) ICC with vascular invasion (3) multi-focal ICC. A 
      Monte Carlo simulation assessed outcomes including quality-adjusted life months 
      (QALMs) and incremental cost-effectiveness ratio (ICER). RESULTS: The net health 
      benefit (NHB) of strategy A versus strategy B was 1.4 QALMs for ICC >6 cm and 1.3 
      QALMs for ICC and vascular invasion; in contrast, there was a negative NHB for HR 
      versus sCT for multi-focal ICC (-0.3 QALMs). In single nodule ICC >6 cm, the ICER 
      of HR versus sCT was $22,482/quality-adjusted life years (QALY) and the ICER of 
      HR versus sCT was $20,953/QALY for ICC with vascular invasion. In multi-focal 
      ICC, the ICER of HR compared with sCT was $83,604/QALY. Patients with a higher 
      American Society of Anesthesiologists score (coefficient 0.94), male sex 
      (coefficient 0.43), low quality of life after sCT (coefficient -2.57) and T3 
      tumors (coefficient 0.53) had a better NHB for HR relative to sCT followed by 
      potential surgery. CONCLUSIONS: For patients with large ICC or ICC and vascular 
      invasion, HR was more cost-effective than sCT. In contrast, HR was not associated 
      with a positive NHB relative to sCT for patients with multi-focal ICC, and 
      therefore these patients should be treated with sCT rather than HR.
FAU - Cillo, Umberto
AU  - Cillo U
AD  - Unita di Chirurgia Epatobiliare e Trapianto Epatico, Azienda 
      Ospedaliera-Universita di Padova, Padua, Italy.
FAU - Spolverato, Gaya
AU  - Spolverato G
FAU - Vitale, Alessandro
AU  - Vitale A
FAU - Ejaz, Aslam
AU  - Ejaz A
FAU - Lonardi, Sara
AU  - Lonardi S
FAU - Cosgrove, David
AU  - Cosgrove D
FAU - Pawlik, Timothy M
AU  - Pawlik TM
LA  - eng
PT  - Journal Article
PL  - United States
TA  - World J Surg
JT  - World journal of surgery
JID - 7704052
SB  - IM
CIN - World J Surg. 2015 Dec;39(12):2965-6. PMID: 26467784
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Bile Duct Neoplasms/drug therapy/*pathology/*surgery
MH  - *Bile Ducts, Intrahepatic
MH  - Blood Vessels/pathology
MH  - Chemotherapy, Adjuvant
MH  - Cholangiocarcinoma/drug therapy/*pathology/*surgery
MH  - Cost-Benefit Analysis
MH  - Female
MH  - Hepatectomy/*economics
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Neoadjuvant Therapy
MH  - Neoplasm Invasiveness
MH  - Neoplasms, Multiple Primary/drug therapy/*pathology/*surgery
MH  - Quality of Life
MH  - Quality-Adjusted Life Years
MH  - Tumor Burden
MH  - Young Adult
EDAT- 2015/07/08 06:00
MHDA- 2016/04/28 06:00
CRDT- 2015/07/08 06:00
PHST- 2015/07/08 06:00 [entrez]
PHST- 2015/07/08 06:00 [pubmed]
PHST- 2016/04/28 06:00 [medline]
AID - 10.1007/s00268-015-3150-1 [doi]
PST - ppublish
SO  - World J Surg. 2015 Oct;39(10):2500-9. doi: 10.1007/s00268-015-3150-1.