Simultaneous versus staged resection for synchronous colorectal liver metastases: A population-based cost analysis in Ontario, Canada - Health economic evaluation

Julian Wang; Christopher Griffiths; Marko Simunovic; Sameer Parpia; Chu-Shu Gu; Amiram Gafni; Leyo Ruo; Julie Hallet; Jessica Bogach; Pablo E Serrano

doi:10.1016/j.ijsu.2020.04.044

Simultaneous versus staged resection for synchronous colorectal liver metastases: A population-based cost analysis in Ontario, Canada - Health economic evaluation

Int J Surg. 2020 Jun:78:75-82. doi: 10.1016/j.ijsu.2020.04.044. Epub 2020 Apr 23.

Authors

Affiliations

¹ Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada.
² Department of Surgery, McMaster University, Hamilton, ON, Canada.
³ Department of Oncology, McMaster University, Hamilton, ON, Canada.
⁴ Ontario Clinical Oncology Group, Hamilton Health Sciences, Hamilton, ON, Canada.
⁵ Department of Health Research Methods, Evaluation and Impact, McMaster University, Hamilton, ON, Canada.
⁶ Department of Surgery, University of Toronto, Toronto, ON, Canada.
⁷ Department of Surgery, McMaster University, Hamilton, ON, Canada. Electronic address: serrano@mcmaster.ca.

PMID: 32335234
DOI: 10.1016/j.ijsu.2020.04.044

Abstract

Background: Simultaneous compared to staged resection of synchronous colorectal cancer liver metastases is considered safe. We aimed to determine their cost implications.

Study design: Population-based cohort was generated by linking administrative healthcare datasets in Ontario, Canada (2006-2014). Resection of colorectal cancer and liver metastases within six months was considered synchronous. Cost analysis was performed from the perspective of a third-party payer. Median costs with range were estimated using the log-normal distribution of cost using t-test with a one-year time horizon.

Results: Among patients undergoing staged resection (n = 678), the estimated median cost was $54,321 CAD (IQR 45,472 to 68,475) and $41,286 CAD (IQR 31,633 to 58,958) for those undergoing simultaneous resection (n = 390), median difference: $13,035 CAD (p < 0.001). Primary cost driver were all costs related to hospitalization for liver and colon resection, which was higher for the staged approach, median difference: $16,346 CAD (p < 0.001). This was mainly due to a longer median length of hospital stay in the staged vs. simultaneous group (11 vs. 8 days, p < 0.001 respectively), which was not attributable to differences in major postoperative complication rates (23% vs. 28%, p = 0.067 respectively). Other costs, including cost of chemotherapy within six months of surgery ($11,681 CAD vs. $8644 CAD, p = 0.074 respectively) and 90-day re-hospitalization cost ($2155 CAD vs. $2931 CAD, p = 0.454 respectively) were similar between groups.

Conclusion: Cost of staged resection of synchronous colorectal cancer liver metastases is significantly higher compared to the simultaneous approach, mostly driven by a longer length of hospital stay despite similar postoperative complication rates.

Keywords: Colorectal cancer; Colorectal liver metastases; Cost analysis; Population-based study; Simultaneous resection; Synchronous metastases.

Publication types

Comparative Study

MeSH terms

Adult
Aged
Cohort Studies
Colorectal Neoplasms / pathology*
Costs and Cost Analysis*
Female
Health Care Costs
Hepatectomy / adverse effects
Hepatectomy / economics*
Humans
Length of Stay
Liver Neoplasms / secondary*
Liver Neoplasms / surgery*
Male
Middle Aged
Neoplasms, Multiple Primary / surgery*