Economic evaluation and budget impact analysis of the surveillance program for hepatocellular carcinoma in Thai chronic hepatitis B patients.
BACKGROUND
The incidence rate and the treatment costs of hepatocellular carcinoma (HCC) are high, especially in Thailand. Previous studies indicated that early detection by a surveillance program could help by down-staging. This study aimed to compare the costs and health outcomes associated with the introduction of a HCC surveillance program with no program and to estimate the budget impact if the HCC surveillance program were implemented.


METHODS
A cost utility analysis using a decision tree and Markov models was used to compare costs and outcomes during the lifetime period based on a societal perspective between alternative HCC surveillance strategies with no program. Costs included direct medical, direct non-medical, and indirect costs. Health outcomes were measured as life years (LYs), and quality adjusted life years (QALYs). The results were presented in terms of the incremental cost-effectiveness ratio (ICER) in Thai THB per QALY gained. One- way and probabilistic sensitivity analyses were applied to investigate parameter uncertainties. Budget impact analysis (BIA) was performed based on the governmental perspective.


RESULTS
Semi-annual ultrasonography (US) and semi-annual ultrasonography plus alpha-fetoprotein (US plus AFP) as the first screening for HCC surveillance would be cost-effective options at the willingness to pay (WTP) threshold of 160,000 THB per QALY gained compared with no surveillance program (ICER=118,796 and ICER=123,451 THB/QALY), respectively. The semi-annual US plus AFP yielded more net monetary benefit, but caused a substantially higher budget (237 to 502 million THB) than semi-annual US (81 to 201 million THB) during the next ten fiscal years.


CONCLUSIONS
Our results suggested that a semi-annual US program should be used as the first screening for HCC surveillance and included in the benefit package of Thai health insurance schemes for both chronic hepatitis B males and females aged between 40-50 years. In addition, policy makers considered the program could be feasible, but additional evidence is needed to support the whole prevention system before the implementation of a strategic plan.
Social and Administrative Pharmacy Excellence Research (SAPER) Unit, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand E-mail : usa.chi@mahidol.ac.th.
Pannapa
P
Sangmala
Usa
U
Chaikledkaew
Tawesak
T
Tanwandee
Petcharat
P
Pongchareonsuk
D000328:Adult; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000191:economics* / Q000453:epidemiology / Q000821:virology; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D006515:Hepatitis B virus / Q000472:pathogenicity*; D019694:Hepatitis B, Chronic / Q000150:complications* / Q000191:economics / Q000821:virology; D006801:Humans; D015994:Incidence; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000191:economics* / Q000453:epidemiology / Q000821:virology; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D011379:Prognosis; D019057:Quality-Adjusted Life Years; D013785:Thailand / Q000453:epidemiology