Cost-effectiveness of liver transplantation in patients with colorectal metastases confined to the liver

Abstract

Background Patients with non‐resectable colorectal metastases are currently treated with chemotherapy. However, liver transplantation can increase the 5‐year survival rate from 9 to 56 per cent if the cancer is confined to the liver. The aim of this study was to estimate the cost‐effectiveness of liver transplantation for colorectal liver metastases. Methods A Markov model with a lifetime perspective was developed to estimate the life‐years, quality‐adjusted life‐years (QALYs), direct healthcare costs and cost‐effectiveness for patients with non‐resectable colorectal liver metastases who received liver transplantation or chemotherapy alone. Results In non‐selected cohorts, liver transplantation increased patients' life expectancy by 3·12 life‐years (2·47 QALYs), at an additional cost of €209 143, giving an incremental cost‐effectiveness ratio (ICER) of €67 140 per life‐year (€84 667 per QALY) gained. In selected cohorts (selection based on tumour diameter, time since primary cancer, carcinoembryonic antigen levels and response to chemotherapy), the effect of liver transplantation increased to 4·23 life‐years (3·41 QALYs), at a higher additional cost (€230 282), and the ICER decreased to €54 467 per life‐year (€67 509 per QALY) gained. Given a willingness to pay of €70 500, the likelihood of transplantation being cost‐effective was 0·66 and 0·94 (0·23 and 0·67 QALYs) for non‐selected and selected cohorts respectively. Conclusion Liver transplantation was cost‐effective but only for highly selected patients. This might be possible in countries with good access to grafts and low waiting list mortality.

Liver segment 2+3 living donation in liver transplantation for colorectal liver metastases

“…Resource allocation and utilization is also a relevant aspect to consider in this discussion. It has been shown by our group that LT of colorectal liver metastases is a reasonable and cost effective treatment in high income countries when selecting "low risk" patients (9). Furthermore, we have also reported that the transplanted patients sustain good quality of life after LT except for the first 3 post-transplant months.…”

Long-Term Survival, Prognostic Factors, and Selection of Patients With Colorectal Cancer for Liver Transplant

“…We have previously shown that patients in the SECA-I trial who received LT had good quality of life up to 3 years after LT . Furthermore, LT is cost-effective compared with the cost of modern oncologic treatments . The major obstacles for being able to offer patients with CRC an LT internationally is the scarcity of donor grafts.…”

Recent advances in liver transplantation for cancer: The future of transplant oncology

“…125 The cost-effectiveness of LT for CRLM in highly selected patients was recently shown. 126 Definitive confirmation of these retrospective findings will hopefully come from several ongoing trials. The SECA-III trial (NCT03494946) will compare LT to best multimodal alternative treatment (chemotherapy +/-locoregional therapies).…”