Increasing incidence and pretransplantation screening of hepatocellular carcinoma.
The incidence of hepatocellular cancer (HCC) in the United States and other traditionally "low-incidence" countries is increasing. 2. The rise in incidence of HCC is related to chronic hepatitis C. 3. Timely performance of liver transplantation is curative in patients with early-stage HCC. 4. Cirrhotic patients, especially those with viral hepatitis, should be screened for HCC. 5. The performance characteristics of current tests are suboptimal, but serial ultrasonography and alphafetaprotein are recommended. 6. Estimated medical charges related to screening and treatment suggest that $285,294 is required per "cured" case. Assuming that this cure is associated with a 75% to 85% chance for high-quality 10-year survival, the charges approximate $35,000 to $40,000/quality-adjusted life-year (QALY). This cost-benefit analysis is nearly identical to published rates for breast cancer screening ($30,000/QALY).
Everson
G T
GT
Liver Transplantation, University of Colorado School of Medicine, Denver, CO 80262, USA. greg.everson@uchsc.edu
D000465:Algorithms; D015415:Biomarkers / Q000097:blood; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology / Q000601:surgery*; D006525:Hepatitis, Viral, Human / Q000150:complications / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D015994:Incidence; D008113:Liver Neoplasms / Q000150:complications / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology / Q000601:surgery*; D016031:Liver Transplantation / Q000191:economics; D011300:Preoperative Care; D011498:Protein Precursors / Q000097:blood; D011516:Prothrombin; D012307:Risk Factors; D009927:Tissue and Organ Procurement; D014463:Ultrasonography; D014850:Waiting Lists; D000509:alpha-Fetoproteins / Q000032:analysis
D015415:Biomarkers; D011498:Protein Precursors; D000509:alpha-Fetoproteins; C008208:acarboxyprothrombin; D011516:Prothrombin