Cost-effectiveness of liver transplantation versus last-resort systematic therapy for colorectal liver metastases

Abstract

Approximately 50 per cent of patients with colorectal cancer have metastases at the time of diagnosis or subsequently develop metastases. The most frequent metastatic site is the liver1–3. Palliative chemotherapy is the treatment option for most patients with colorectal liver metastases (CRLMs). Regorafenib and TAS-102 have recently been approved by the European Medicines Agency and US Food and Drug Administration for patients with CRLMs who have progressed from second- or third-line treatments4–6. In randomized studies, regorafenib and TAS-102 prolonged median overall survival by 1.4–1.8 months compared with best supportive care (BSC)7,8. The authors have previously shown that deceased-donor liver transplantation (LT) is a cost-effective treatment alternative for patients with CRLMs compared with chemotherapy alone, particularly for selected low-risk patients (those with a low Oslo Score)9,10. LT may also be an option for patients with advanced liver-only CRLMs11. In the present study, a previously validated model was used to evaluate the cost-effectiveness of LT in patients with progressive disease, for whom the only available treatment options were TAS-102, regorafenib or BSC9.