A Systematic Review and Narrative Synthesis of Health Economic Evaluations of Hepatocellular Carcinoma Screening Strategies

Nguyen, Anh Thu; Nguyen, Hoa Thi Thu; Yee, KC; Palmer, Andrew J.; Blizzard, Christopher Leigh; Graaff, Barbara de

doi:10.1016/j.jval.2020.11.014

Cited by 8 publications

(9 citation statements)

References 104 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The adherence rate to HCC surveillance has only been taken into account in a small number of economic evaluations of HCC surveillance in the past and those studies revealed higher adherence rates were associated with higher costs and effectiveness of the surveillance [ 4 ]. Our model showed surveillance with real-world adherence rates was extendedly dominated by a fully adhered surveillance program for compensated and decompensated cirrhosis populations.…”

Section: Discussionmentioning

confidence: 99%

“…The most common form of PLC is hepatocellular carcinoma (HCC), which accounts for more than 80% of total PLC cases [ 2 ]. In Australia, although mortality rates of many cancers have plateaued or reduced, cancer death due to HCC is rising [ 3 ], making it the fastest increasing cause of cancer mortality in this country [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

“…The studies used modelling techniques to evaluate the cost and outcomes of different surveillance strategies to inform decision making. A recent systematic review has shown most of these evaluations were cost-effective, but their results need to be interpreted with care due to limitations existing within those studies [ 4 ]. For that reason, we have developed a health economic evaluation model, based on the Australian consensus statement, that takes into account the limitations of previous models.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

Nguyen

Liu

Lubel

et al. 2023

BMC Health Serv Res

Self Cite

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

Nguyen

Liu

Lubel

et al. 2023

BMC Health Serv Res

Self Cite

View full text Add to dashboard Cite

show abstract

“…Unfortunately, this study was not designed as an evaluation of health economics, so the following assumptions were based on previous studies in the literature. A systematic review by Nguyen et al regarding the evaluation of health economics for hepatocellular carcinoma screening strategies confirmed that CT and MRI are clinically more effective than US when performed at the same intervals, but they are much more costly [ 24 ]. Lima et al compared imaging-based surveillance and diagnostic strategies for patients who were at risk of hepatocellular carcinoma (HCC) while taking into account technically inadequate examinations and patient compliance [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

Two-Phase MDCT Protocol for the Screening of Small Hepatocellular Carcinoma

Pathil

Boursier

Dabli

et al. 2022

JCM

View full text Add to dashboard Cite

Screening programmes for cirrhotic patients are based on ultrasound (US) examinations at 6-month intervals, but a US sensitivity of 47% has recently been reported. The aim of this study was to evaluate a two-phase MDCT protocol in terms of hepatic nodule detection within a hepatocellular carcinoma (HCC) screening situation and to evaluate a reduction in irradiation dose for the 6-monthly checks compared to the classic four-phase protocol. In total, 373 patients with 498 nodules that were suspected to be HCC and ranged from 10 to 30 mm in size were prospectively included. All patients underwent four-phase MDCT with an unenhanced phase, arterial phase (AP), portal phase (PP) and delayed phase (DP). The cumulative irradiation from the repeated 6-monthly MDCT protocol was calculated. Of the 498 nodules, only 4 (0.008%) were only seen in the PP and not in the AP or AP. Of the 319 HCC nodules, 270 (84.6%) had AP hyperenhancement, while 115 had washout in the PP and 224 had washout in the DP. Overall, 222 of the 224 (99.1%) HCC nodules with typical features were seen in the AP and DP. The dose reduction was estimated at 55.4% when using the two-phase protocol (AP and DP). The cumulative irradiation of the two-phase protocol, which was performed every 6 months over 5 years, was 96.5 mSv. MDCT with the two-phase protocol could offer an alternative to ultrasound screening with an interesting risk–benefit trade-off.

show abstract

“…A key component of any screening strategy is ensuring it offers good value for money; that is, the strategy is cost effective. The majority of studies evaluating the cost-effectiveness of screening consider patients with cirrhosis, with a minority of studies looking at hepatitis B being mostly focused on Asian populations [ 51 ]. In studies comparing screening using abdominal ultrasound +/− AFP with no screening [ 52 , 53 , 54 , 55 , 56 ], screening programs were cost effective in all but one study [ 55 ].…”

Section: Screening For Hepatocellular Carcinomamentioning

confidence: 99%

Screening for Hepatocellular Carcinoma in Patients with Hepatitis B

Sachar

Brahmania

Dhanasekaran

et al. 2021

Viruses

View full text Add to dashboard Cite

Chronic hepatitis B (CHB) infection is a significant risk factor for developing hepatocellular carcinoma (HCC). As HCC is associated with significant morbidity and mortality, screening patients with CHB at a high risk for HCC is recommended in an attempt to improve these outcomes. However, the screening recommendations on who to screen and how often are not uniform. Identifying patients at the highest risk of HCC would allow for the best use of health resources. In this review, we evaluate the literature on screening patients with CHB for HCC, strategies for optimizing adherence to screening, and potential risk stratification tools to identify patients with CHB at a high risk of developing HCC.

show abstract

A Systematic Review and Narrative Synthesis of Health Economic Evaluations of Hepatocellular Carcinoma Screening Strategies

Cited by 8 publications

References 104 publications

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

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

Two-Phase MDCT Protocol for the Screening of Small Hepatocellular Carcinoma

Screening for Hepatocellular Carcinoma in Patients with Hepatitis B

Contact Info

Product

Resources

About