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.
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Article info
Publication history
Published online: May 18, 2015
Accepted:
March 4,
2015
Footnotes
G.S. and A.V. contributed equally to this manuscript.
Identification
Copyright
© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
