PMID- 28266967
OWN - NLM
STAT- MEDLINE
DCOM- 20170612
LR  - 20190225
IS  - 1528-1140 (Electronic)
IS  - 0003-4932 (Linking)
VI  - 265
IP  - 4
DP  - 2017 Apr
TI  - Liver Resection for Breast Cancer Liver Metastases: A Cost-utility Analysis.
PG  - 792-799
LID - 10.1097/SLA.0000000000001715 [doi]
AB  - OBJECTIVE: To estimate the cost-effectiveness of liver resection followed by 
      adjuvant systemic therapy relative to systemic therapy alone for patients with 
      breast cancer liver metastasis. BACKGROUND: Data on cost-effectiveness of liver 
      resection for advanced breast cancer with liver metastasis are lacking. METHODS: 
      A decision-analytic Markov model was constructed to evaluate the 
      cost-effectiveness of liver resection followed by postoperative conventional 
      systemic therapy (strategy A) versus conventional therapy alone (strategy B) 
      versus newer targeted therapy alone (strategy C). The implications of using 
      different chemotherapeutic regimens based on estrogen receptor and human 
      epidermal growth factor receptor 2 status was also assessed. Outcomes included 
      quality-adjusted life months (QALMs), incremental cost-effectiveness ratio, and 
      net health benefit (NHB). RESULTS: NHB of strategy A was 10.9 QALMs compared with 
      strategy B when letrozole was used as systemic therapy, whereas it was only 0.3 
      QALMs when docetaxel + trastuzumab was used as a systemic therapy. The addition 
      of newer biological agents (strategy C) significantly decreased the 
      cost-effectiveness of strategy B (conventional systemic therapy alone). The NHB 
      of strategy A was 31.6 QALMs versus strategy C when palbociclib was included in 
      strategy C; similarly, strategy A had a NHB of 13.8 QALMs versus strategy C when 
      pertuzumab was included in strategy C. Monte-Carlo simulation demonstrated that 
      the main factor influencing NHB of strategy A over strategy C was the cost of 
      systemic therapy. CONCLUSIONS: Liver resection in patients with breast cancer 
      liver metastasis proved to be cost-effective when compared with systemic therapy 
      alone, particularly in estrogen receptor-positive tumors or when newer agents 
      were used.
FAU - Spolverato, Gaya
AU  - Spolverato G
AD  - *Department of Surgery, Division of Surgical Oncology, The Johns Hopkins 
      Hospital, Baltimore, MD daggerUnita di Chirurgia Epatobiliare e Trapianto Epatico, 
      Azienda Ospedaliera-Universita di Padova, Padova, Italy double daggerSidney Kimmel 
      Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD.
FAU - Vitale, Alessandro
AU  - Vitale A
FAU - Bagante, Fabio
AU  - Bagante F
FAU - Connolly, Roisin
AU  - Connolly R
FAU - Pawlik, Timothy M
AU  - Pawlik TM
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - United States
TA  - Ann Surg
JT  - Annals of surgery
JID - 0372354
RN  - 0 (Antibodies, Monoclonal, Humanized)
RN  - 0 (Nitriles)
RN  - 0 (Piperazines)
RN  - 0 (Pyridines)
RN  - 0 (Taxoids)
RN  - 0 (Triazoles)
RN  - 15H5577CQD (Docetaxel)
RN  - 7LKK855W8I (Letrozole)
RN  - G9ZF61LE7G (palbociclib)
RN  - K16AIQ8CTM (pertuzumab)
SB  - IM
MH  - Antibodies, Monoclonal, Humanized/administration & dosage/economics
MH  - Antineoplastic Combined Chemotherapy Protocols/*administration & dosage/economics
MH  - Breast Neoplasms/mortality/*pathology/therapy
MH  - Chemotherapy, Adjuvant/economics/methods
MH  - *Cost-Benefit Analysis
MH  - Disease-Free Survival
MH  - Docetaxel
MH  - Female
MH  - Hepatectomy/*economics/methods
MH  - Humans
MH  - Letrozole
MH  - Liver Neoplasms/drug therapy/mortality/*secondary/*surgery
MH  - Male
MH  - Markov Chains
MH  - Neoplasm Invasiveness/pathology
MH  - Neoplasm Staging
MH  - Nitriles/administration & dosage/economics
MH  - Piperazines/administration & dosage/economics
MH  - Pyridines/administration & dosage/economics
MH  - Quality-Adjusted Life Years
MH  - Survival Rate
MH  - Taxoids/administration & dosage/economics
MH  - Triazoles/administration & dosage/economics
EDAT- 2017/03/08 06:00
MHDA- 2017/03/08 06:01
CRDT- 2017/03/08 06:00
PHST- 2017/03/08 06:00 [entrez]
PHST- 2017/03/08 06:00 [pubmed]
PHST- 2017/03/08 06:01 [medline]
AID - 00000658-201704000-00027 [pii]
AID - 10.1097/SLA.0000000000001715 [doi]
PST - ppublish
SO  - Ann Surg. 2017 Apr;265(4):792-799. doi: 10.1097/SLA.0000000000001715.