Cost-effectiveness analysis on the surveillance for hepatocellular carcinoma in liver cirrhosis patients using contrast-enhanced ultrasonography.
OBJECTIVE
Sonazoid is a new contrast agent for ultrasonography (US). Contrast-enhanced ultrasonography (CEUS) using Sonazoid enables Kupffer imaging, which improves the sensitivity of hepatocellular carcinoma (HCC) detection. However, there are no studies on the cost-effectiveness of HCC surveillance using Sonazoid.


METHODS
We constructed a Markov model simulating the natural history of HCV-related liver cirrhosis (LC) patients, and compared three strategies (no surveillance, US surveillance and CEUS surveillance). The transition probability and cost data were obtained from published data. The simulation and analysis were performed using TreeAge pro 2009 software.


RESULTS
When compared to the no surveillance group, the US and CEUS surveillance groups increased the life expectancy by 1.67 and 1.99 quality-adjusted life-years (QALY), respectively, and the incremental cost effectiveness ratio (ICER) were 17 296 $US/QALY and 18 384 $US/QALY, respectively. These results were both less than the commonly-accepted threshold of $US 50 000/QALY. Even if the CEUS surveillance group was compared with the US surveillance group, the ICER was $US 24 250 and thus cost-effective. Sensitivity analysis showed that the annual incidence of HCC and CEUS sensitivity were two critical parameters. However, when the annual incidence of HCC is more than 2% and/or the CEUS sensitivity is more than 80%, the ICER was also cost-effective.


CONCLUSIONS
Contrast-enhanced ultrasonography surveillance for HCC is a cost-effective strategy for LC patients and gains their longest additional life years, with similar degree of ICER in the US surveillance group. CEUS surveillance using Sonazoid is expected to be used not only in Japan, but also world-wide.
Division of Hepatobiliary and Pancreatic Disease, and Department of Internal Medicine             Ultrasound Imaging Center, Hyogo College of Medicine, Nishinomiya, Hyogo             Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan             School of Health Information Sciences, University of Texas Health Science Center-Houston, Houston, USA.
Hironori
H
Tanaka
Hiroko
H
Iijima
Kazuhiro
K
Nouso
Noriaki
N
Aoki
Takashi
T
Iwai
Tomoyuki
T
Takashima
Yoshiyuki
Y
Sakai
Nobuhiro
N
Aizawa
Kazunari
K
Iwata
Naoto
N
Ikeda
Yoshinori
Y
Iwata
Hirayuki
H
Enomoto
Masaki
M
Saito
Hiroyasu
H
Imanishi
Shuhei
S
Nishiguchi