Early detection and curative treatment of hepatocellular carcinoma: A cost-effectiveness analysis in France and in the United States.
Hepatocellular carcinoma (HCC) is the leading cause of death in patients with cirrhosis. Patients outside clinical trials seldom benefit from evidence-based monitoring. The objective of this study was to estimate the cost-effectiveness of complying with HCC screening guidelines. The economic evaluation compared surveillance of patients with cirrhosis as recommended by the guidelines ("gold-standard monitoring") to "real-life monitoring" from the health care system perspective. A Markov model described the history of the disease and treatment course including current first-line curative treatment: liver resection, radiofrequency ablation (RFA), and liver transplantation. Transition probabilities were derived mainly from two French cohorts, CIRVIR and CHANGH. Costs were computed using French and U.S. tariffs. Effectiveness was measured in life years gained (LYG). An incremental cost-effectiveness ratio (ICER) was calculated for a 10-year horizon and tested with one-way and probabilistic sensitivity analyses. The cost difference between the two groups was $648 ($87,476 in the gold-standard monitoring group vs. $86,829 in the real-life monitoring group) in France and $11,965 ($93,795 vs. $81,829) in the United States. Survival increased by 0.37 years (7.18 vs. 6.81 years). The ICER was $1,754 per LYG in France and $32,415 per LYG in the United States. The health gain resulted from earlier diagnosis and access to first-line curative treatments, among which RFA provided the best value for money.



Our results indicate that gold-standard monitoring for patients with cirrhosis is cost-effective, attributed to a higher probability of benefiting from a curative treatment and so a higher survival probability. (Hepatology 2017;65:1237-1248).
AP-HP, Health economics research unit, Paris, France.|ECEVE, UMRS 1123, French National Institute of Health and Medical Research, Paris, France.
Benjamin
B
Cadier
AP-HP, Health economics research unit, Paris, France.
Julie
J
Bulsei
AP-HP, Department of Hepatology, Jean Verdier hospital, Bondy, France.|French League Against Cancer; Education and Research in Health Medicine and Human Biology, University Paris 13, Sorbonne Paris Cité, Paris, France.|Unité mixte de Recherche 1162, Génomique fonctionnelle des Tumeurs solides, Institut National de la Santé et de la Recherche médicale, Paris, France.
Pierre
P
Nahon
Unité mixte de Recherche 1162, Génomique fonctionnelle des Tumeurs solides, Institut National de la Santé et de la Recherche médicale, Paris, France.|AP-HP, Department of Radiology, Jean Verdier hospital, Bondy, France.
Olivier
O
Seror
AP-HP, Department of Hepatobiliary and Digestive Surgery, Henri Mondor hospital, Creteil l, France.|University Paris-Est, Creteil, France.|Inserm U955-Creteil, France.
Alexis
A
Laurent
CHANGH study Group, Hepatology and Gastroenterology Department, Centre Hospitalier Intercommunal de Créteil, Creteil, France.
Isabelle
I
Rosa
AP-HP, Department of Public Health, Henri Mondor hospital, Creteil, France.|University Paris-Est, A-TVB DHU, CEpiA (Clinical Epidemiology and Aging) Unit EA4393, University Paris-Est, Creteil, France.
Richard
R
Layese
AP-HP, Department of Hepatology, Henri Mondor hospital, Créteil, France.
Charlotte
C
Costentin
Unit for Basic and Clinical research on Viral Hepatitis, ANRS (France REcherche Nord & sud Sida-HIV Hépatites-FRENSH), Paris, France.
Carole
C
Cagnot
AP-HP, Health economics research unit, Paris, France.|ECEVE, UMRS 1123, French National Institute of Health and Medical Research, Paris, France.|AP-HP, Department of Public Health, Henri Mondor hospital, Creteil, France.
Isabelle
I
Durand-Zaleski
AP-HP, Health economics research unit, Paris, France.|ECEVE, UMRS 1123, French National Institute of Health and Medical Research, Paris, France.|University Paris Diderot, Sorbonne Paris Cite, Paris, France.
Karine
K
Chevreul
D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000191:economics* / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D017115:Catheter Ablation / Q000191:economics / Q000379:methods / Q000401:mortality; D015331:Cohort Studies; D003362:Cost-Benefit Analysis / Q000379:methods*; D016208:Databases, Factual; D018572:Disease-Free Survival; D055088:Early Detection of Cancer / Q000191:economics* / Q000379:methods; D005260:Female; D005602:France; D006498:Hepatectomy / Q000191:economics / Q000379:methods / Q000401:mortality; D006801:Humans; D008113:Liver Neoplasms / Q000191:economics* / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation / Q000191:economics / Q000379:methods / Q000401:mortality; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis; D014481:United States