{Reference Type}: Journal Article
{Title}: Hepatocellular carcinoma surveillance based on the Australian Consensus Guidelines: a health economic modelling study.
{Author}: Nguyen ALT;Si L;Lubel JS;Shackel N;Yee KC;Wilson M;Bradshaw J;Hardy K;Palmer AJ;Blizzard CL;de Graaff B;
{Journal}: BMC Health Serv Res
{Volume}: 23
{Issue}: 1
{Year}: 2023 Apr 19
{Factor}: 2.908
{DOI}: 10.1186/s12913-023-09360-4
{Abstract}: <B>BACKGROUND: </B>Hepatocellular carcinoma (HCC) is the fastest increasing cause of cancer death in Australia. A recent Australian consensus guidelines recommended HCC surveillance for cirrhotic patients and non-cirrhotic chronic hepatitis B (CHB) patients at gender and age specific cut-offs. A cost-effectiveness model was then developed to assess surveillance strategies in Australia.<BR><B>METHODS: </B>A microsimulation model was used to evaluate three strategies: biannual ultrasound, biannual ultrasound with alpha-fetoprotein (AFP) and no formal surveillance for patients having one of the conditions: non-cirrhotic CHB, compensated cirrhosis or decompensated cirrhosis. One-way and probabilistic sensitivity analyses as well as scenario and threshold analyses were conducted to account for uncertainties: including exclusive surveillance of CHB, compensated cirrhosis or decompensated cirrhosis populations; impact of obesity on ultrasound sensitivity; real-world adherence rate; and different cohort's ranges of ages.<BR><B>RESULTS: </B>Sixty HCC surveillance scenarios were considered for the baseline population. The ultrasound + AFP strategy was the most cost-effective with incremental cost-effectiveness ratios (ICER) compared to no surveillance falling below the willingness-to-pay threshold of A$50,000 per quality-adjusted life year (QALY) at all age ranges. Ultrasound alone was also cost-effective, but the strategy was dominated by ultrasound + AFP. Surveillance was cost-effective in the compensated and decompensated cirrhosis populations alone (ICERs < $30,000), but not cost-effective in the CHB population (ICERs > $100,000). Obesity could decrease the diagnostic performance of ultrasound, which in turn, reduce the cost-effectiveness of ultrasound ± AFP, but the strategies remained cost-effective.<BR><B>CONCLUSIONS: </B>HCC surveillance based on Australian recommendations using biannual ultrasound ± AFP was cost-effective.