BMC Health Services Research (Apr 2023)

Hepatocellular carcinoma surveillance based on the Australian Consensus Guidelines: a health economic modelling study

  • Anh Le Tuan Nguyen,
  • Lei Si,
  • John S Lubel,
  • Nicholas Shackel,
  • Kwang Chien Yee,
  • Mark Wilson,
  • Jane Bradshaw,
  • Kerry Hardy,
  • Andrew John Palmer,
  • Christopher Leigh Blizzard,
  • Barbara de Graaff

DOI
https://doi.org/10.1186/s12913-023-09360-4
Journal volume & issue
Vol. 23, no. 1
pp. 1 – 15

Abstract

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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 $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.

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