• K J Roberts, A J Sutton, K R Prasad, G J Toogood, and J P A Lodge.
• Department of Hepatobiliary and Pancreatic Surgery, University Hospitals Birmingham, Leeds, UK.
• Br J Surg. 2015 Mar 1;102(4):388-98.

BackgroundSurgical resection of colorectal liver metastases (CRLMs) is the standard of care when possible, although this strategy has not been compared with non-operative interventions in controlled trials. Although survival outcomes are clear, the cost-effectiveness of surgery is not. This study aimed to estimate the cost-effectiveness of resection for CRLMs compared with non-operative treatment (palliative care including chemotherapy).MethodsOperative and non-operative cohorts were identified from a prospectively maintained database. Patients in the operative cohort had a minimum of 10 years of follow-up. A model-based cost-utility analysis was conducted to quantify the mean cost and quality-adjusted life-years (QALYs) over a lifetime time horizon. The analysis was conducted from a healthcare provider perspective (UK National Health Service) in a secondary care (hospital) setting.ResultsMedian survival was 41 and 21 months in the operative and non-operative cohorts respectively (P < 0·001). The operative strategy dominated non-operative treatments, being less costly (€22,200 versus €32,800) and more effective (4·017 versus 1·111 QALYs gained). The results of extensive sensitivity analysis showed that the operative strategy dominated non-operative treatment in every scenario.ConclusionOperative treatment of CRLMs yields greater survival than non-operative treatment, and is both more effective and less costly.© 2015 BJS Society Ltd Published by John Wiley & Sons Ltd.

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