Cost-effectiveness of screening for hepatocellular carcinoma among subjects at different levels of risk.
OBJECTIVE
The American Association for the Study of Liver Diseases 2005 practice guidelines for management of hepatocellular carcinoma (HCC) recommends that various high-risk groups of people undergo HCC surveillance. Our study aimed to investigate whether screening for HCC among subjects with early-stage cirrhosis is more cost-effective than screening among chronic hepatitis B virus (HBV) carriers without cirrhosis.


METHODS
Markov-based decision models were constructed to simulate development and progression of cirrhosis and HCC in the following 2 cohorts: subjects with early-stage cirrhosis and subjects who are chronic HBV carriers but do not have cirrhosis. The models also were used to estimate the incremental cost-effectiveness ratio (ICER) for each cohort over a time horizon of 25 years.


RESULTS
The average cost per person was less and the average effect was greater for the cohort of chronic HBV carriers without cirrhosis than for the cohort of subjects with cirrhosis. The incremental effects for use of the screening strategy and the non-screening strategy in the 2 cohorts were 0.28 years and 0.86 years, respectively. The ICERs for the 2 cohorts were $25,578 and $15,191, respectively. The cohort of chronic HBV carriers had a greater ICER with respect to the HCC screening programme because of the smaller incremental effect. The sensitivity analyses revealed that HCC incidence and the probability of accidental diagnosis of HCC were critical parameters in the model.


CONCLUSIONS
Screening for HCC among subjects with early-stage cirrhosis is more cost-effective than screening among chronic HBV carriers who do not have cirrhosis.
Chang
Yaojen
Y
Institute for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA. y-chang@north-western.edu
Lairson
David R
DR
Chan
Wenyaw
W
Lu
Sheng-Nan
SN
Aoki
Noriaki
N
D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis*; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D042241:Early Diagnosis; D005260:Female; D006509:Hepatitis B; D006515:Hepatitis B virus / Q000302:isolation & purification; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis*; D008297:Male; D008390:Markov Chains; D008403:Mass Screening / Q000191:economics*; D008875:Middle Aged; D018570:Risk Assessment; D013624:Taiwan