Antiviral therapy for hepatitis B-related liver cancer prevention is more cost-effective than cancer screening.
OBJECTIVE
In Australia, Asian-born populations are 6-12 times more likely to develop hepatocellular cancer (HCC) than Australian-born individuals. We therefore, modelled the consequences of different management strategies for chronic hepatitis B (CHB) in Asian-born adults aged > or = 35 years.


METHODS
A Markov model compared (1) enhanced surveillance for HCC alone (HCC surveillance), or (2) enhanced HCC surveillance coupled with CHB treatment (HCC prevention) to the current practice, of low CHB treatment uptake. Patients were stratified and managed according to risk categories, based upon hepatitis B virus (HBV) viral load and alanine aminotransferase (ALT) levels. We measured costs, health outcomes [cases of HCC and deaths averted, quality-adjusted life-years (QALYs) gained] and incremental cost-effectiveness ratios (ICERs).


RESULTS
HCC surveillance would cost on average AU$8479 per person, compared to AU$2632 with current clinical practice and result in a gain of 0.014 QALYs (AU$401,516/QALY gained). A HCC prevention strategy would cost on average AU$14,600 per person, result in 0.923 QALYs gained (AU$12,956/QALY gained), reduce cases of cirrhosis by 52%, HCC diagnoses by 47% and CHB-related deaths by 56%, compared to current practice.


CONCLUSIONS
HCC prevention appears to be a cost-effective public health strategy in at-risk populations in Australia and is preferable to HCC surveillance as a cancer control strategy.
Robotin
Monica C
MC
The Cancer Council NSW, Research Strategy and Scientific Development Unit, 153 Dowling St, Woolloomooloo, NSW 2011, Sydney, Australia. monicar@nswcc.org.au
Kansil
Melanie
M
Howard
Kirsten
K
George
Jacob
J
Tipper
Steven
S
Dore
Gregory J
GJ
Levy
Miriam
M
Penman
Andrew G
AG
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000410:Alanine Transaminase / Q000378:metabolism; D000998:Antiviral Agents / Q000191:economics* / Q000627:therapeutic use*; D001208:Asia / Q000208:ethnology; D001315:Australia; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000517:prevention & control* / Q000821:virology; D003362:Cost-Benefit Analysis; D018450:Disease Progression; D006515:Hepatitis B virus / Q000502:physiology; D019694:Hepatitis B, Chronic / Q000150:complications / Q000188:drug therapy* / Q000208:ethnology; D006801:Humans; D008099:Liver / Q000201:enzymology / Q000821:virology; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000517:prevention & control* / Q000821:virology; D008390:Markov Chains; D008403:Mass Screening / Q000191:economics*; D008875:Middle Aged; D011159:Population Surveillance; D019057:Quality-Adjusted Life Years; D012680:Sensitivity and Specificity; D019562:Viral Load
D000998:Antiviral Agents; D000410:Alanine Transaminase