Cost-effectiveness of the surveillance program of hepatocellular carcinoma depends on the medical circumstances.
OBJECTIVE
The clinical features of hepatocellular carcinoma (HCC) and the medical environment are diverse in different geographic areas. The aim of this study is to evaluate the cost-effectiveness of the surveillance of HCC in different medical circumstances.


METHODS
The Markov model focused on variables that differ from country to country and may change in the future, especially in regards to the proportion of small HCC detected incidentally. The target population was 45-year-old patients with Child-Pugh class A cirrhosis, and the intervention was surveillance with ultrasonography every 6 months.


RESULTS
The additional cost of the surveillance was $US15 100, the gain in quality-adjusted life years (QALYs) was 0.50 years, and the incremental cost-effectiveness ratio (ICER) was $US29 900/QALY in a base-case analysis (annual incidence of HCC = 4%). If 40% of small HCC were detected incidentally without surveillance, the gain in QALY decreased to 0.15 and the ICER increased to $US47 900/QALY. The increase in the annual incidence of HCC to 8% resulted in the increase of QALYs to 0.81, and the decrease of the ICER to $US25 400/QALY. The adoption of liver transplantation increased the gain in QALYs and the ICER to 0.84 and $US59 900/QALY, respectively.


CONCLUSIONS
The gain in QALYs and the ICER due to the surveillance of HCC varies between different patient subgroups and it critically depends on the rate of small HCC detected incidentally without surveillance, as well as the annual incidence of HCC and the adoption of liver transplantation.
Nouso
Kazuhiro
K
Department of Internal Medicine, Hiroshima City Hospital, Hiroshima, Japan. nouso@cc.okayama-u.ac.jp
Tanaka
Hironori
H
Uematsu
Shuji
S
Shiraga
Kunihiro
K
Okamoto
Ryoichi
R
Onishi
Hideki
H
Nakamura
Shin-Ichiro
S
Kobayashi
Yoshiyuki
Y
Araki
Yasuyuki
Y
Aoki
Noriaki
N
Shiratori
Yasushi
Y
D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000191:economics / Q000453:epidemiology / Q000209:etiology; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D017048:Health Care Costs; D006801:Humans; D015994:Incidence; D033162:Incidental Findings; D008103:Liver Cirrhosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000191:economics / Q000601:surgery; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000191:economics / Q000453:epidemiology / Q000209:etiology; D016031:Liver Transplantation / Q000191:economics; D008390:Markov Chains; D008403:Mass Screening / Q000191:economics* / Q000379:methods; D008875:Middle Aged; D015397:Program Evaluation; D019057:Quality-Adjusted Life Years; D015203:Reproducibility of Results; D012111:Residence Characteristics; D012720:Severity of Illness Index; D013997:Time Factors; D014463:Ultrasonography / Q000191:economics*