title: Cost-effectiveness of semi-annual surveillance for hepatocellular carcinoma in cirrhotic patients of the Italian Liver Cancer population.
abstract: OBJECTIVE
  It was recently shown that semi-annual surveillance for hepatocellular carcinoma (HCC) in cirrhotic patients provides a prognostic advantage over the annual program; however, its cost-effectiveness (CE) in the general cirrhotic population still needs to be defined.
  
  
  METHODS
  A Markov model was built to compare CE of these two strategies, considering literature results and treatment modalities of 918 cirrhotic patients from the Italian Liver Cancer (ITA.LI.CA) database.
  
  
  RESULTS
  Results from the Markov model suggest that, compared to annual surveillance, semi-annual surveillance leads to a gain in quality-adjusted life expectancy, in an unselected cirrhotic population, of 1.35 quality-adjusted life-months (QALMs) over 10 years since surveillance start in compensated patients, and of 0.73 QALMs in decompensated patients. Semi-annual surveillance was more cost-effective in compensated than in decompensated cirrhosis, with an incremental CE ratio (ICER) of 1997 and 3814€/QALM, respectively. In compensated cirrhosis, semi-annual surveillance was more cost-effective than the annual program when the annual HCC incidence was ≥3.2% and the relative survival gain after cancer diagnosis was ≥20% with respect to the annual program. In decompensated cirrhosis, semi-annual surveillance was cost-effective in patients amenable to liver transplantation. In both groups, CE of semi-annual surveillance improved with the increase of annual incidence and the survival benefit obtainable with HCC treatment.
  
  
  CONCLUSIONS
  Both surveillance strategies for HCC in cirrhotic patients can be recommended, according to the individual risk profile for HCC occurrence and the expected survival gain obtainable after tumor diagnosis and therapy.
authors.affiliation: Dipartimento di Discipline Chirurgiche, Rianimatorie e dei Trapianti, Alma Mater Studiorum - Università di Bologna, Italy. Electronic address: aleqko@libero.it.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Cucchetti
authors.affiliation: Dipartimento di Medicina Clinica, Unità di Semeiotica Medica, Alma Mater Studiorum - Università di Bologna, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Trevisani
authors.affiliation: Dipartimento di Discipline Chirurgiche, Rianimatorie e dei Trapianti, Alma Mater Studiorum - Università di Bologna, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Cescon
authors.affiliation: Dipartimento di Discipline Chirurgiche, Rianimatorie e dei Trapianti, Alma Mater Studiorum - Università di Bologna, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Ercolani
authors.affiliation: Dipartimento di Scienze Chirurgiche e Gastroenterologiche, Unità di Gastroenterologia, Università di Padova, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Farinati
authors.affiliation: Divisione di Medicina, Ospedale Treviglio-Caravaggio, Treviglio, Italy.
authors.forename: Paolo Del
authors.initials: PD
authors.lastname: Poggio
authors.affiliation: Unità di Medicina Interna e Gastroenterologia, Università Cattolica di Roma, Roma, Italy.
authors.forename: Gianludovico
authors.initials: G
authors.lastname: Rapaccini
authors.affiliation: Divisione di Medicina, Azienda Ospedaliera Bolognini, Seriate, Italy.
authors.forename: Maria Anna Di
authors.initials: MAD
authors.lastname: Nolfo
authors.affiliation: Dipartimento di Medicina Clinica e Sperimentale, Unità di Medicina, Università di Padova, Italy.
authors.forename: Luisa
authors.initials: L
authors.lastname: Benvegnù
authors.affiliation: Dipartimento di Medicina Interna, dell'Invecchiamento e Malattie Nefrologiche, Unità di Medicina Interna, Alma Mater Studiorum - Università di Bologna, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Zoli
authors.affiliation: Dipartimento di Medicina, Unità di Medicina Interna ed Epatologia, Ospedale Fatebenefratelli, Milano, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Borzio
authors.affiliation: Dipartimento di Medicina Interna, Unità di Gastroenterologia, Università di Genova, Italy.
authors.forename: Edoardo Giovanni
authors.initials: EG
authors.lastname: Giannini
authors.affiliation: Unità di Gastroenterologia, Ospedale Belcolle, Viterbo, Italy.
authors.forename: Eugenio
authors.initials: E
authors.lastname: Caturelli
authors.affiliation: Unità di Gastroenterologia, Ospedale Sacro Cuore Don Calabria, Negrar, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Chiaramonte
authors.affiliation: Dipartimento di Discipline Chirurgiche, Rianimatorie e dei Trapianti, Alma Mater Studiorum - Università di Bologna, Italy.
authors.forename: Antonio Daniele
authors.initials: AD
authors.lastname: Pinna
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008103:Liver Cirrhosis / Q000150:complications* / Q000208:ethnology*; D008113:Liver Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D011159:Population Surveillance / Q000379:methods*; D011379:Prognosis; D012307:Risk Factors; D015996:Survival Rate