A cost-utility analysis of liver resection for malignant tumours: A pilot project.

摘要

his study is a pilot cost-utility analysis comparing hepatic resection, radiofrequency ablation (RFA), systemic chemotherapy, and symptom control only for the treatment of colorectal liver metastases. It is a prospective, non-randomized, observational study, which did not influence the type of treatment received. All patients with newly diagnosed liver malignancies of any type who were referred to a hepatobiliary surgeon or to medical oncologists at CancerCare Manitoba (CCMB) at the St. Boniface General Hospital (SBGH) were eligible. Quality of life, in terms of utility, was measured serially with the Health Utilities Index Mark II and III. Costs, in 2001 Canadian dollars, were captured from the viewpoint of society in general, including hospital costs, outpatient medical costs, and costs borne by patients themselves. A cost-utility analysis was then performed with the aid of decision analysis techniques.;Forty patients were enrolled in the study. Seven patients underwent hepatic resection, 7 patients underwent RFA (sometimes in combination with resection), 20 patients received systemic chemotherapy, and 6 patients received symptom control alone. The sample size is small and the treatments were not randomized. Liver resection was the most effective treatment, providing an average benefit of 2.51 quality-adjusted life years (QALY's) compared to 1.99 QALY's for RFA, and 1.18 QALY's for chemotherapy, and 0.82 QALY's for symptom control alone. The costs were