Department of Health Management and Health Economics, University of Oslo, Oslo, Norway.
Research group for Transplant Oncology, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway.
Med Decis Making. 2024 Jul;44(5):529-542. doi: 10.1177/0272989X241249154. Epub 2024 Jun 3.
Liver transplantation is an alternative treatment for patients with nonresectable colorectal cancer liver-only metastases (CRLM); however, the potential effects on wait-list time and life expectancy to other patients on the transplant waiting list have not been considered. We explored the potential effects of expanding liver transplantation eligibility to include patients with CRLM on wait-list time and life expectancy in Norway.
We developed a discrete event simulation model to reflect the Norwegian liver transplantation waiting list process and included 2 groups: 1) patients currently eligible for liver transplantation and 2) CRLM patients. Under 2 alternative CRLM-patient transplant eligibility criteria, we simulated 2 strategies: 1) inclusion of only currently eligible patients (CRLM patients received standard-of-care palliative chemotherapy) and 2) expanding waiting list eligibility to include CRLM patients under 2 eligibility criteria. Model outcomes included median waiting list time, life expectancy, and total life-years.
For every additional CRLM patient listed per year, the overall median wait-list time, initially 52 d, increased by 8% to 11%. Adding 2 additional CRLM patients under the most restrictive eligibility criteria increased the CRLM patients' average life expectancy by 10.64 y and decreased the average life expectancy for currently eligible patients by 0.05 y. Under these assumptions, there was a net gain of 149.61 life-years over a 10-y programmatic period, which continued to increase under scenarios of adding 10 CRLM patients to the wait-list. Health gains were lower under less restrictive CRLM eligibility criteria. For example, adding 4 additional CRLM patients under the less restrictive eligibility criteria increased the CRLM patients' average life expectancy by 5.64 y and decreased the average life expectancy for currently eligible patients by 0.12 y. Under these assumptions, there was a net gain of 96.36 life-years over a 10-y programmatic period, which continued to increase up to 7 CRLM patients.
Our model-based analysis enabled the consideration of the potential effects of enlisting Norwegian CRLM patients for liver transplantation on wait-list time and life expectancy. Enlisting CRLM patients is expected to increase the total health effects, which supports the implementation of liver transplantation for CRLM patients in Norway.
Given the Norwegian donor liver availability, adding patients with nonresectable colorectal cancer liver-only metastases (CRLM) to the liver transplantation waiting list had an overall modest, but varying, impact on total waiting list time.Survival gains for selected CRLM patients treated with liver transplantation would likely outweigh the losses incurred to patients listed currently.To improve the total life-years gained in the population, Norway should consider expanding the treatment options for CRLM patients to include liver transplantation.Other countries may also have an opportunity to gain total life-years by extending the waiting list eligibility criteria; however, country-specific analyses are required.
肝移植是治疗结直肠癌肝转移（CRLM）不可切除患者的一种替代治疗方法；然而，对于移植等候名单上的其他患者，肝移植对等候时间和预期寿命的潜在影响尚未得到考虑。我们探讨了在挪威扩大肝移植资格标准，将 CRLM 患者纳入等候名单对等候时间和预期寿命的潜在影响。
我们开发了一个离散事件模拟模型来反映挪威肝移植等候名单的处理过程，并包括 2 组：1）目前有资格接受肝移植的患者和 2）CRLM 患者。在两种替代的 CRLM 患者移植资格标准下，我们模拟了 2 种策略：1）仅纳入目前有资格的患者（CRLM 患者接受标准的姑息性化疗）和 2）根据 2 种资格标准扩大等候名单资格，纳入 CRLM 患者。模型结果包括中位等候名单时间、预期寿命和总寿命年数。
每年每增加一名 CRLM 患者，整体中位等候名单时间从最初的 52 天增加 8%至 11%。根据最严格的资格标准，增加 2 名额外的 CRLM 患者，将 CRLM 患者的平均预期寿命延长 10.64 年，并将目前有资格的患者的平均预期寿命缩短 0.05 年。根据这些假设，在 10 年的方案期间，将获得 149.61 个寿命年的净收益，并且在将 10 名 CRLM 患者列入等候名单的情况下，这一收益将继续增加。在不太严格的 CRLM 资格标准下，健康获益较低。例如，根据不太严格的资格标准，增加 4 名额外的 CRLM 患者，将 CRLM 患者的平均预期寿命延长 5.64 年，并将目前有资格的患者的平均预期寿命缩短 0.12 年。根据这些假设，在 10 年的方案期间，将获得 96.36 个寿命年的净收益，并且在增加 7 名 CRLM 患者的情况下，这一收益将继续增加。
我们的基于模型的分析使人们能够考虑在挪威将 CRLM 患者纳入肝移植等候名单对等候时间和预期寿命的潜在影响。招募 CRLM 患者有望增加总体健康效果，这支持在挪威为 CRLM 患者实施肝移植。
鉴于挪威供肝的可用性，将患有不可切除结直肠癌肝转移（CRLM）的患者列入肝移植等候名单对总等候名单时间有一定的影响，但程度不同。对接受肝移植治疗的选定 CRLM 患者的生存获益可能超过对目前列入名单的患者的损失。为了提高人群的总寿命年数，挪威应考虑扩大 CRLM 患者的治疗选择，包括肝移植。其他国家也有可能通过扩大等候名单资格标准来获得总寿命年数；然而，需要进行特定国家的分析。
