Cost-effectiveness of screening for hepatocellular carcinoma in patients with cirrhosis due to chronic hepatitis C.
BACKGROUND
Screening for hepatocellular carcinoma in cirrhotic patients using abdominal ultrasonography and alpha-foetoprotein levels is widely practiced.


OBJECTIVE
To evaluate its cost-effectiveness using a Markov decision model.


METHODS
Several screening strategies with abdominal ultrasonography or computerized tomography and serum alpha-foetoprotein at 6-12-month intervals in 40-year-old patients with chronic hepatitis C and compensated cirrhosis were simulated from a societal perspective, resulting in discounted costs per quality-adjusted life-year saved. Extensive sensitivity analysis was performed.


RESULTS
For the least efficacious strategy, annual alpha-foetoprotein/ultrasonography, the incremental cost-effectiveness ratio (vs. no screening) was $23 043/quality-adjusted life-year. Biannual alpha-foetoprotein/annual ultrasonography, the most commonly used strategy in the United States, was more efficacious, with a cost-effectiveness ratio of $33 083/quality-adjusted life-year vs. annual alpha-foetoprotein/ultrasonography. The most efficacious strategy, biannual alpha-foetoprotein/ultrasonography, resulted in a cost-effectiveness ratio of $73 789/quality-adjusted life-year vs. biannual alpha-foetoprotein/annual ultrasonography. Biannual alpha-foetoprotein/annual computerized tomography screening resulted in a cost-effectiveness ratio of $51 750/quality-adjusted life-year vs. biannual alpha-foetoprotein/annual ultrasonography screening.


CONCLUSIONS
Screening for hepatocellular carcinoma is as cost-effective as other accepted screening protocols. Of the strategies evaluated, biannual alpha-foetoprotein/annual ultrasonography gives the most quality-adjusted life-year gain while still maintaining a cost-effectiveness ratio <$50 000/quality-adjusted life-year. Biannual alpha-foetoprotein/annual computerized tomography screening may be cost-effective.
Lin
O S
OS
Gastroenterology Section, Virginia Mason Medical Center, Seattle, WA, USA. otto.lin@vmmc.org
Keeffe
E B
EB
Sanders
G D
GD
Owens
D K
DK
D006528:Carcinoma, Hepatocellular / Q000191:economics / Q000517:prevention & control*; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000191:economics; D006801:Humans; D008103:Liver Cirrhosis / Q000191:economics / Q000821:virology*; D008113:Liver Neoplasms / Q000191:economics / Q000517:prevention & control*; D008390:Markov Chains; D008403:Mass Screening / Q000191:economics*; D018803:Models, Economic; D011336:Probability; D019057:Quality-Adjusted Life Years; D012680:Sensitivity and Specificity