Cost-effectiveness of hepatocellular carcinoma surveillance in patients with hepatitis C virus-related cirrhosis.
OBJECTIVE
HCV-related cirrhosis is a leading risk factor for hepatocellular carcinoma (HCC). Surveillance might detect HCC at a treatable stage. We estimated the clinical and economic consequences of a common HCC surveillance strategy in patients with HCV-related cirrhosis in the context of alternative HCC treatment strategies.


METHODS
With a Markov model, we examined surveillance with serum alpha-fetoprotein and ultrasound every 6 months in patients with compensated HCV-related cirrhosis from age 45-70 years or death, and HCC treatment with resection, cadaveric liver transplantation (CLT), or living donor liver transplantation (LDLT).


RESULTS
Compared to natural history in the base case, surveillance with resection, listing for CLT, or LDLT increased life expectancy by 0.49, 2.58, and 3.81 quality-adjusted life-years (QALYs), respectively, all at costs less than 51,000 US dollars/QALY gained. The consequences of surveillance were most sensitive to the outcomes and costs of HCC treatments but not surveillance test performance characteristics or cost. Prioritizing CLT for patients with HCC over those with decompensated cirrhosis resulted in greater overall life expectancy with minimal increase in cost.


CONCLUSIONS
Surveillance for HCC in patients with compensated HCV-related cirrhosis might gain QALYs at acceptable costs. The impact of surveillance depends most on the outcomes and costs of HCC treatments, rather than surveillance test characteristics. By increasing organ availability for timely definitive treatment, LDLT might achieve the greatest gain in life expectancy at acceptable costs. Prioritizing CLT for HCC might increase the population-wide benefits of CLT.
Patel
Derek
D
Division of Gastroenterology, Department of Medicine, University of California, 513 Parnassus Avenue, San Francisco, CA 94143-0538, USA.
Terrault
Norah A
NA
Yao
Francis Y
FY
Bass
Nathan M
NM
Ladabaum
Uri
U
D000328:Adult; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000191:economics / Q000209:etiology / Q000601:surgery; D019411:Clinical Laboratory Techniques / Q000191:economics; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D006526:Hepatitis C / Q000097:blood / Q000150:complications* / Q000000981:diagnostic imaging; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood / Q000000981:diagnostic imaging / Q000821:virology*; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000191:economics / Q000209:etiology / Q000601:surgery; D016031:Liver Transplantation / Q000191:economics; D008875:Middle Aged; D009010:Monte Carlo Method; D019057:Quality-Adjusted Life Years; D014463:Ultrasonography / Q000191:economics*; D000509:alpha-Fetoproteins / Q000378:metabolism*
D000509:alpha-Fetoproteins