| dc.description.abstract | Background: In Norway, the standard of care for patients with non-resectable colorectal cancer with liver-only metastasis (NCRLM) is palliative chemotherapy alone, which results in a dismal 5-year overall survival rate of 10 percent. The current two trials of offering liver transplantation from a deceased donor to NCRLM patients in Norway, namely SECA-I and SECA-II, each with a different set of criteria, have proven improvement on life year saved for the patients, increasing the 5-year overall survival rate to 60% and 83%, respectively. Sjule and Vinter discovered, however, that the inclusion of NCRLM on the current deceased liver waiting list in Norway comes at the expense of the existing Status Quo patients on the list. The inclusion of NCRLM patients can result in longer waiting times and a reduction in life year for Status Quo patients. Living donor liver transplantation has the potential to be offered to NCRLM patients with the same efficacy as liver transplantation from deceased donors as a result of recent advances in surgical technique. In addition, a previous study by Bjrnevol et al. demonstrated that offering NCRLM patients deceased liver transplantation was cost-effective for highly selected patients. Objective: This study aims to build a model to assess cost-effectiveness of both deceased and living donor liver transplantation for NCRLM patients, from both perspective of NCRLM group only and the entire population where there is spillover effect. Methods: All three patient groups, NCRLM, Status Quo, and donors, were simulated using a discrete event simulation (DES) model across three strategies for NCRLM patients: palliative care only, deceased liver transplantation, and living donor liver transplantation. DES was chosen since it is a flexible model that allows for interaction among groups of patients. Results: The model results show that, the expected cost per life year gain of living donor transplantation was 655,643.0 NOK under NCRLM perspective and 1,038,151.9 NOK for entire population perspective. In all circumstance, the highest cost per QALY gain for deceased liver transplantation was 805,342.6 NOK Conclusion: Living donor transplantation was no longer cost-effective when the cost per life year saved criterion was applied from a broader perspective, whereas deceased liver transplantation remained cost-effective in all circumstances. Spillover effect can alter the cost-effectiveness of a strategy. | eng |