Froelich Matthias F, Schnitzer Moritz L, Rathmann Nils, Tollens Fabian, Unterrainer Marcus, Rennebaum Shereen, Seidensticker Max, Ricke Jens, Rübenthaler Johannes, Kunz Wolfgang G
Department of Radiology and Nuclear Medicine, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany.
Cancers (Basel). 2021 Mar 25;13(7):1507. doi: 10.3390/cancers13071507.
Colorectal cancer is among the most prevalent cancer entities worldwide, with every second patient developing liver metastases during their illness. For local treatment of liver metastases, a surgical approach as well as ablative treatment options, such as microwave ablation (MWA) and radiofrequency ablation (RFA), are available. The aim of this study is to evaluate the cost-effectiveness of RFA, MWA and surgery in the treatment of liver metastases of oligometastatic colorectal cancer (omCRC) that are amenable for all investigated treatment modalities.
A decision analysis based on a Markov model assessed lifetime costs and quality-adjusted life years (QALY) related to the treatment strategies RFA, MWA and surgical resection. Input parameters were based on the best available and most recent evidence. Probabilistic sensitivity analyses (PSA) were performed with Monte Carlo simulations to evaluate model robustness. The percentage of cost-effective iterations was determined for different willingness-to-pay (WTP) thresholds.
The base-case analysis showed that surgery led to higher long-term costs compared to RFA and MWA (USD 41,848 vs. USD 36,937 vs. USD 35,234), while providing better long-term outcomes than RFA, yet slightly lower than MWA (6.80 vs. 6.30 vs. 6.95 QALYs for surgery, RFA and MWA, respectively). In PSA, MWA was the most cost-effective strategy for all WTP thresholds below USD 80,000 per QALY.
In omCRC patients with liver metastases, MWA and surgery are estimated to provide comparable efficacy. MWA was identified as the most cost-effective strategy in intermediate resource settings and should be considered as an alternative to surgery in high resource settings.
结直肠癌是全球最常见的癌症类型之一，每两名患者中就有一人在患病期间会发生肝转移。对于肝转移的局部治疗，有手术方法以及消融治疗选项，如微波消融（MWA）和射频消融（RFA）。本研究的目的是评估RFA、MWA和手术在治疗适用于所有研究治疗方式的寡转移性结直肠癌（omCRC）肝转移中的成本效益。
基于马尔可夫模型的决策分析评估了与RFA、MWA和手术切除治疗策略相关的终身成本和质量调整生命年（QALY）。输入参数基于现有最佳和最新证据。通过蒙特卡罗模拟进行概率敏感性分析（PSA）以评估模型的稳健性。针对不同的支付意愿（WTP）阈值确定具有成本效益的迭代百分比。
基础案例分析表明，与RFA和MWA相比，手术导致更高的长期成本（分别为41,848美元、36,937美元和35,234美元），同时提供比RFA更好的长期结果，但略低于MWA（手术、RFA和MWA的QALY分别为6.80、6.30和6.95）。在PSA中，对于所有低于每QALY 80,000美元的WTP阈值，MWA是最具成本效益的策略。
在伴有肝转移的omCRC患者中，估计MWA和手术具有相当的疗效。在中等资源环境中，MWA被确定为最具成本效益的策略，在高资源环境中应被视为手术的替代方案。
