Economic evaluation of a surveillance program of hepatocellular carcinoma (HCC) in India.
OBJECTIVE
Surveillance of patients of cirrhosis of liver is practiced for early detection of HCC. No data from any developing country on cost-effectiveness of such a program are available.


METHODS
Economic evaluation of HCC surveillance was embedded in a prospective study undertaken to estimate the incidence of HCC in 194 cirrhotics. The protocol consisted of 6 monthly abdominal ultrasound (US) and serum alphafetoprotein (AFP) estimation, and yearly triple phase CT. Cost was estimated from the hospital and patient perspectives. Cost-effectiveness ratios for detecting a case of HCC were estimated. Modeling was done to estimate cost effectiveness with different combinations of diagnostic tests.


RESULTS
Cost-effectiveness ratios of HCC surveillance program per HCC case detected were estimated as US$ 280 from the hospital perspective. From patient perspective, these were US$ 9,965 for outstation and US$ 2,808 for local patients. Cost-effectiveness ratio for direct medical cost per case of HCC detected by 6 monthly US and AFP, the EASL protocol, was estimated to be US$ 1,510 in the private sector.


CONCLUSIONS
The cost of HCC surveillance program is exorbitant for India (gross national income per capita US$ 620) and possibly other low/middle income countries.
Paul
Shashi Bala
SB
Department of Radio-diagnosis, All India Institute of Medical Sciences, New Delhi, 110029, India.
Sreenivas
Vishnubhatla
V
Gulati
Manpreet Singh
MS
Madan
Kaushal
K
Gupta
Arun Kumar
AK
Mukhopadhyay
Sima
S
Acharya
Subrat Kumar
SK