title: Cost-effectiveness analysis of population-based screening of hepatocellular carcinoma: Comparing ultrasonography with two-stage screening.
abstract: OBJECTIVE
  To assess the cost-effectiveness of two population-based hepatocellular carcinoma (HCC) screening programs, two-stage biomarker-ultrasound method and mass screening using abdominal ultrasonography (AUS).
  
  
  METHODS
  In this study, we applied a Markov decision model with a societal perspective and a lifetime horizon for the general population-based cohorts in an area with high HCC incidence, such as Taiwan. The accuracy of biomarkers and ultrasonography was estimated from published meta-analyses. The costs of surveillance, diagnosis, and treatment were based on a combination of published literature, Medicare payments, and medical expenditure at the National Taiwan University Hospital. The main outcome measure was cost per life-year gained with a 3% annual discount rate.
  
  
  RESULTS
  The results show that the mass screening using AUS was associated with an incremental cost-effectiveness ratio of USD39825 per life-year gained, whereas two-stage screening was associated with an incremental cost-effectiveness ratio of USD49733 per life-year gained, as compared with no screening. Screening programs with an initial screening age of 50 years old and biennial screening interval were the most cost-effective. These findings were sensitive to the costs of screening tools and the specificity of biomarker screening.
  
  
  CONCLUSIONS
  Mass screening using AUS is more cost effective than two-stage biomarker-ultrasound screening. The most optimal strategy is an initial screening age at 50 years old with a 2-year inter-screening interval.
authors.affiliation: Ming-Jeng Kuo, Department of Hepatogastroenterology, Tainan Municipal Hospital, Tainan 701, Taiwan.
authors.forename: Ming-Jeng
authors.initials: MJ
authors.lastname: Kuo
authors.affiliation: Ming-Jeng Kuo, Department of Hepatogastroenterology, Tainan Municipal Hospital, Tainan 701, Taiwan.
authors.forename: Hsiu-Hsi
authors.initials: HH
authors.lastname: Chen
authors.affiliation: Ming-Jeng Kuo, Department of Hepatogastroenterology, Tainan Municipal Hospital, Tainan 701, Taiwan.
authors.forename: Chi-Ling
authors.initials: CL
authors.lastname: Chen
authors.affiliation: Ming-Jeng Kuo, Department of Hepatogastroenterology, Tainan Municipal Hospital, Tainan 701, Taiwan.
authors.forename: Jean Ching-Yuan
authors.initials: JC
authors.lastname: Fann
authors.affiliation: Ming-Jeng Kuo, Department of Hepatogastroenterology, Tainan Municipal Hospital, Tainan 701, Taiwan.
authors.forename: Sam Li-Sheng
authors.initials: SL
authors.lastname: Chen
authors.affiliation: Ming-Jeng Kuo, Department of Hepatogastroenterology, Tainan Municipal Hospital, Tainan 701, Taiwan.
authors.forename: Sherry Yueh-Hsia
authors.initials: SY
authors.lastname: Chiu
authors.affiliation: Ming-Jeng Kuo, Department of Hepatogastroenterology, Tainan Municipal Hospital, Tainan 701, Taiwan.
authors.forename: Yu-Min
authors.initials: YM
authors.lastname: Lin
authors.affiliation: Ming-Jeng Kuo, Department of Hepatogastroenterology, Tainan Municipal Hospital, Tainan 701, Taiwan.
authors.forename: Chao-Sheng
authors.initials: CS
authors.lastname: Liao
authors.affiliation: Ming-Jeng Kuo, Department of Hepatogastroenterology, Tainan Municipal Hospital, Tainan 701, Taiwan.
authors.forename: Hung-Chuen
authors.initials: HC
authors.lastname: Chang
authors.affiliation: Ming-Jeng Kuo, Department of Hepatogastroenterology, Tainan Municipal Hospital, Tainan 701, Taiwan.
authors.forename: Yueh-Shih
authors.initials: YS
authors.lastname: Lin
authors.affiliation: Ming-Jeng Kuo, Department of Hepatogastroenterology, Tainan Municipal Hospital, Tainan 701, Taiwan.
authors.forename: Amy Ming-Fang
authors.initials: AM
authors.lastname: Yen
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood*; D001774:Blood Chemical Analysis / Q000191:economics*; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000191:economics*; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D055088:Early Detection of Cancer / Q000191:economics* / Q000379:methods; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008113:Liver Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000191:economics*; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D018803:Models, Economic; D011237:Predictive Value of Tests; D011379:Prognosis; D015203:Reproducibility of Results; D013624:Taiwan; D014463:Ultrasonography / Q000191:economics*
chemical_list: D015415:Biomarkers
keywords: Age; Cost-effectiveness; Markov model; One-stage abdominal ultrasonography screening; Sensitivity analysis; Two-stage biomarker-ultrasound screening