Treatment of colorectal liver metastases by cryotherapy

The clinical effectiveness and cost-effectiveness of ablative therapies in the management of liver metastases: systematic review and economic evaluation

“…117 No evidence was found on condition-specific preference-based measures (expected to offer greater resolution of patients' HRQoL than a generic instrument such as the EQ-5D) either. At the time of writing, the EORTC QLQ-LMC21 is the only instrument specific to liver metastases available; however, this is a non-preference-based tool and no publications on its mapping into EQ-5D have been found.…”

“…117 Both included economic evaluations concern a health-care system -Medicare, a US social insurance programme designed specifically for citizens aged 65 or older -that is not comparable with the UK NHS, which comprises the entire population. Though the patient groups of these studies are relevant for our review in terms of pathology, they may differ significantly from the population of interest for the UK NHS in other characteristics due to the patient selection inherent in the different health-care systems.…”

“…The rationale for a 2-year model and discounting was not discussed. 115 A lifetime horizon would have been more appropriate; 117 however, given the advanced stage of these patients' disease, 2 years may be close to their lifetime. The assumptions made adopting this type of analysis are not listed and the discussion of them is very limited.…”

“…Moreover, none of the studies used effectiveness estimates that had been found through a systematic review of the literature or report HRQoL estimates from a standardised validated preference-based instrument, as per UK guidance for technology appraisal. 117 Abramson and colleagues 115 offer limited data useful to the current decision problem as the modelling approach adopted does not reflect the disease process and the estimation of health benefits did not consider patients' HRQoL, hence a cost-utility analysis (standard method for UK technology appraisal) 117 was not performed.…”

“…However, their cost-utility analysis does not follow UK standard methodology 117 as the estimation of health benefits and the perspective adopted are inappropriate. HRQoL estimates used by Gazelle and colleagues 116 are assumptions based on Earlam and colleagues' study, 121 which had used several nonpreference-based instruments to measure the quality of life of patients with colorectal liver metastases.…”