title: Hepatocellular carcinoma surveillance rates in commercially insured patients with noncirrhotic chronic hepatitis B.
abstract: American association for the study of liver diseases (AASLD) and European Association for the Study of the Liver (EASL) guidelines recommend biannual hepatocellular carcinoma (HCC) screening for noncirrhotic patients with chronic hepatitis B infection (HBV), yet there are no data estimating surveillance rates or factors associated with surveillance. We performed a retrospective cohort study of US patients using the Truven Health Analytics databases from 2006 to 2010 and identified patients with noncirrhotic chronic HBV. Surveillance patterns were characterized using categorical and continuous outcomes, with the continuous measure of the proportion of time 'up to date' with surveillance (PUTDS), with the 6-month interval following each ultrasound categorized as 'up to date'. During a median follow-up of 26.0 (IQR: 16.2-40.0) months among 4576 noncirrhotic patients with chronic HBV (median age: 44 years, IQR: 36-52), only 306 (6.7%) had complete surveillance (one ultrasound every 6-month interval), 2727 (59.6%) incomplete (≥1 ultrasound) and 1543 (33.7%) none. The mean PUTDS was 0.34 ± 0.29, and the median was 0.32 (IQR: 0.03-0.52). In multinomial logistic regression models, patients diagnosed by a nongastroenterologist were significantly less likely to have complete surveillance (P < 0.001), as were those coinfected with HBV/HIV (P < 0.001). In linear regression models, nongastroenterologist provider, health insurance subtype, HBV/HIV coinfection, rural status and metabolic syndrome were independently associated with decreased surveillance. Patients with HIV had an absolute decrease in the PUTDS of 0.24, while patients in less populated rural areas had an absolute decrease of 0.10. HCC surveillance rates in noncirrhotic patients with chronic HBV in the United States are poor and lower than reported rates of HCC surveillance in cirrhotic patients.
authors.affiliation: Division of Gastroenterology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.|Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA.|Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: D S
authors.initials: DS
authors.lastname: Goldberg
authors.affiliation: Bayer HealthCare, Bayer HealthCare Pharmaceuticals, Wayne, NJ, USA.
authors.forename: A
authors.initials: A
authors.lastname: Valderrama
authors.affiliation: Bayer HealthCare, Bayer HealthCare Pharmaceuticals, Wayne, NJ, USA.
authors.forename: R
authors.initials: R
authors.lastname: Kamalakar
authors.affiliation: Department of Pharmaceutical Health Outcomes and Policy, University of Houston, Houston, TX, USA.
authors.forename: S S
authors.initials: SS
authors.lastname: Sansgiry
authors.affiliation: Bayer HealthCare, Bayer HealthCare Pharmaceuticals, Wayne, NJ, USA.
authors.forename: S
authors.initials: S
authors.lastname: Babajanyan
authors.affiliation: Division of Gastroenterology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.|Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA.|Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: J D
authors.initials: JD
authors.lastname: Lewis
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis*; D003955:Diagnostic Tests, Routine / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility; D006302:Health Services Research; D019694:Hepatitis B, Chronic / Q000150:complications*; D006801:Humans; D007348:Insurance, Health; D008113:Liver Neoplasms / Q000175:diagnosis*; D008297:Male; D008403:Mass Screening / Q000379:methods* / Q000706:statistics & numerical data; D008875:Middle Aged; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: Ultrasound; chronic hepatitis B; hepatocellular carcinoma; surveillance