Surveillance of stage IV colorectal cancer (CRC) after curative-intent metastasectomy can be effective for detecting asymptomatic recurrence. Guidelines for various forms of surveillance exist but are supported by limited evidence. We aimed to determine the most cost-effective strategy for surveillance following curative-intent metastasectomy of stage IV CRC. We performed a decision analysis to compare four active surveillance strategies involving clinic visits and investigations elicited from National Comprehensive Cancer Network (NCCN) recommendations. Markov model inputs included data from a population-based cohort and literature-derived costs, utilities, and probabilities. The primary outcomes were costs (2021 Canadian dollars) and quality-adjusted life years (QALYs) gained. Over a 10-year base-case time horizon, surveillance with follow-ups every 12 months for 5 years was most economically favourable at a willingness-to-pay threshold of CAD 50,000 per QALY. These patterns were generally robust in the sensitivity analysis. A more intensive surveillance strategy was only favourable with a much higher willingness-to-pay threshold of approximately CAD 425,000 per QALY, with follow-ups every 3 months for 2 years then every 12 months for 3 additional years. Our findings are consistent with NCCN guidelines and justify the need for additional research to determine the impact of surveillance on CRC outcomes.
对接受根治性转移灶切除术后的IV期结直肠癌患者进行监测，可有效发现无症状复发。目前虽存在多种监测方案指南，但支持证据有限。本研究旨在确定IV期结直肠癌根治性转移灶切除术后最具成本效益的监测策略。我们通过决策分析比较了四种主动监测方案，这些方案基于美国国家综合癌症网络指南制定，包含门诊随访及检查项目。马尔可夫模型参数来源于基于人群的队列数据及文献获取的成本、效用值和概率数据。主要结局指标为成本（以2021年加元计）和质量调整生命年增益。在10年基础案例时间范围内，以每质量调整生命年支付意愿阈值5万加元为标准，术后5年内每12个月随访一次的监测方案最具经济优势。敏感性分析显示该结论总体稳健。更密集的监测方案（术后2年内每3个月随访一次，随后3年每12个月随访一次）仅在支付意愿阈值达到约42.5万加元/质量调整生命年时才显现优势。本研究结果与美国国家综合癌症网络指南相符，并证实需要进一步研究以明确监测方案对结直肠癌临床结局的影响。
Cost-Effectiveness of Surveillance after Metastasectomy of Stage IV Colorectal Cancer
肿瘤(癌症)患者之家