Cost-effectiveness analysis of a two-stage screening intervention for hepatocellular carcinoma in Taiwan.
OBJECTIVE
Hepatocellular carcinoma (HCC) has been the leading cause of cancer death in Taiwan since the 1980s. A two-stage screening intervention was introduced in 1996 and has been implemented in a limited number of hospitals. The present study assessed the costs and health outcomes associated with the introduction of screening intervention, from the perspective of the Taiwanese government. The cost-effectiveness analysis aimed to assist informed decision making by the health authority in Taiwan.


METHODS
A two-phase economic model, 1-year decision analysis and a 60-year Markov simulation, was developed to conceptualize the screening intervention within current practice, and was compared with opportunistic screening alone. Incremental analyses were conducted to compare the incremental costs and outcomes associated with the introduction of the intervention. Sensitivity analyses were performed to investigate the uncertainties that surrounded the model.


RESULTS
The Markov model simulation demonstrated an incremental cost-effectiveness ratio (ICER) of NT$498,000 (US$15,600) per life-year saved, with a 5% discount rate. An ICER of NT$402,000 (US$12,600) per quality-adjusted life-year was achieved by applying utility weights. Sensitivity analysis showed that excess mortality reduction of HCC by screening and HCC incidence rates were the most influential factors on the ICERs. Scenario analysis also indicated that expansion of the HCC screening intervention by focusing on regular monitoring of the high-risk individuals could achieve a more favorable result.


CONCLUSIONS
Screening the population of high-risk individuals for HCC with the two-stage screening intervention in Taiwan is considered potentially cost-effective compared with opportunistic screening in the target population of an HCC endemic area.
Shih
Sophy Ting-Fang
ST
Deakin Health Economics, Public Health Research Policy and Evaluation Cluster, Deakin University, Victoria, Australia. sophy.shih@deakin.edu.au
Crowley
Steve
S
Sheu
Jin-Chuan
JC
D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000191:economics; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D017048:Health Care Costs; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000191:economics; D008390:Markov Chains; D008403:Mass Screening / Q000191:economics* / Q000379:methods; D018803:Models, Economic; D010043:Outcome and Process Assessment, Health Care / Q000191:economics; D011320:Primary Health Care; D013624:Taiwan