Health Economic Evaluation of Patients With Colorectal Liver Metastases Randomized to ALPPS or TSH: Analysis From the LIGRO Trial

Kristina Hasselgren, MD, PhD; Martin Henriksson, PhD; Bård I. Røsok, MD, PhD; Peter N. Larsen, MD, PhD; Ernesto Sparrelid, MD, PhD; Gert Lindell, MD, PhD; Nicolai A. Schultz, MD, PhD; Bjorn A. Bjørnbeth, MD, PhD; Bengt Isaksson, MD, PhD; Magnus Rizell, MD, PhD; Anna Lindhoff Larsson, RN; Per Sandström, MD, PhD; Bergthor Björnsson, MD, PhD

doi:10.1097/AS9.0000000000000367

Annals of Surgery Open (Mar 2024)

Health Economic Evaluation of Patients With Colorectal Liver Metastases Randomized to ALPPS or TSH: Analysis From the LIGRO Trial

Kristina Hasselgren, MD, PhD,
Martin Henriksson, PhD,
Bård I. Røsok, MD, PhD,
Peter N. Larsen, MD, PhD,
Ernesto Sparrelid, MD, PhD,
Gert Lindell, MD, PhD,
Nicolai A. Schultz, MD, PhD,
Bjorn A. Bjørnbeth, MD, PhD,
Bengt Isaksson, MD, PhD,
Magnus Rizell, MD, PhD,
Anna Lindhoff Larsson, RN,
Per Sandström, MD, PhD,
Bergthor Björnsson, MD, PhD

Affiliations

Kristina Hasselgren, MD, PhD: * From the Division of surgery, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
Martin Henriksson, PhD: † Centre for Medical Technology Assessment, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
Bård I. Røsok, MD, PhD: ‡ Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway
Peter N. Larsen, MD, PhD: § Department of Surgical Gastroenterology and Transplantation, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
Ernesto Sparrelid, MD, PhD: ‖ Department of Clinical Science, Intervention and Technology, Division of Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
Gert Lindell, MD, PhD: ¶ Department of Surgery, Skane University Hospital, Lund, Sweden
Nicolai A. Schultz, MD, PhD: § Department of Surgical Gastroenterology and Transplantation, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
Bjorn A. Bjørnbeth, MD, PhD: ‡ Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway
Bengt Isaksson, MD, PhD: # Department of Surgery, Akademiska University Hospital, Uppsala, Sweden
Magnus Rizell, MD, PhD: ** Department of Transplantation and Liver Surgery, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Anna Lindhoff Larsson, RN: * From the Division of surgery, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
Per Sandström, MD, PhD: * From the Division of surgery, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
Bergthor Björnsson, MD, PhD: * From the Division of surgery, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden

DOI: https://doi.org/10.1097/AS9.0000000000000367
Journal volume & issue: Vol. 5, no. 1
p. e367

Abstract

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Objective:. This is a preplanned, health economic evaluation from the LIGRO trial. One hundred patients with colorectal liver metastases (CRLM) and standardized future liver remnant <30% were randomized to associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) or two-staged hepatectomy (TSH). Summary Background Data:. TSH, is an established method in advanced CRLM. ALPPS has emerged providing improved resection rate and survival. The health care costs and health outcomes, combining health-related quality of life (HRQoL) and survival into quality-adjusted life years (QALYs), of ALPPS and TSH have not previously been evaluated and compared. Methods:. Costs and QALYs were compared from treatment start up to 2 years. Costs are estimated from resource use, including all surgical interventions, length of stay after interventions, diagnostic procedures and chemotherapy, and applying Swedish unit costs. QALYs were estimated by combining survival and HRQoL data, the latter being assessed with EQ-5D 3L. Estimated costs and QALYs for each treatment strategy were combined into an incremental cost-effectiveness ratio (ICER). Nonparametric bootstrapping was used to assess the joint distribution of incremental costs and QALYs. Results:. The mean cost difference between ALPPS and TSH was 12,662€, [95% confidence interval (CI): −10,728–36,051; P = 0.283]. Corresponding mean difference in life years and QALYs was 0.1296 (95% CI: −0.12–0.38; P = 0.314) and 0.1285 (95% CI: −0.11–0.36; P = 0.28), respectively. The ICER was 93,186 and 92,414 for QALYs and life years as outcomes, respectively. Conclusions:. Based on the 2-year data, the cost-effectiveness of ALPPS is uncertain. Further research, exploring cost and health outcomes beyond 2 years is needed.

Published in Annals of Surgery Open

ISSN: 2691-3593 (Online)
Publisher: Wolters Kluwer Health
Country of publisher: United States
LCC subjects: Medicine: Surgery
Website: https://journals.lww.com/aosopen/pages/default.aspx

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