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- Title
Hepatocellular carcinoma surveillance based on the Australian Consensus Guidelines: a health economic modelling study.
- Authors
Nguyen, Anh Le Tuan; Si, Lei; Lubel, John S; Shackel, Nicholas; Yee, Kwang Chien; Wilson, Mark; Bradshaw, Jane; Hardy, Kerry; Palmer, Andrew John; Blizzard, Christopher Leigh; de Graaff, Barbara
- Abstract
Background: 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. Methods: 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. Results: 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. Conclusions: HCC surveillance based on Australian recommendations using biannual ultrasound ± AFP was cost-effective.
- Subjects
AUSTRALIA; HEPATOCELLULAR carcinoma; DIAGNOSTIC ultrasonic imaging; ECONOMIC models; CHRONIC hepatitis B; QUALITY-adjusted life years
- Publication
BMC Health Services Research, 2023, Vol 23, Issue 1, p1
- ISSN
1472-6963
- Publication type
Article
- DOI
10.1186/s12913-023-09360-4