Cost-Effectiveness of Liver Cancer Screening in Adults at High Risk for Liver Cancer in the Republic of Korea

Abstract

PurposeThis study was conducted in order to determine the most cost-effective strategy, in terms of interval and age range, forliver cancer screening in the high-risk population of Korea.Materials and MethodsA stochastic modelwas used to simulate the cost-effectiveness ofliver cancer screening by combined ultrasonography and alpha-fetoprotein testing when varying both screening intervals and age ranges. The effectiveness of these screening strategies in the high-risk population was defined as the probability of detecting preclinical liver cancer, and costwas based on the direct cost ofthe screening and confirmative tests. Optimal cost-effectiveness was determined using the incremental cost-effectiveness ratio. ResultsAmong the 36 alternative strategies, one-year or two-year interval screening for men aged between 50 and 80 years, six-month or one-year interval screening for men aged between 40 and 80 years, and six-month interval screening for men aged between 30 and 80 years were identified as non-dominated strategies. For women, identified non-dominated strategies were: one-year interval screening between age 50 and 65 years, one-year or six-month interval screening between age 50 and 80 years, six-month interval screening between age 40 and 80 years, and six-month interval screening between age 30 and 80 years. ConclusionIn Korea, a one-year screening interval for men aged 50 to 80 years would be marginally cost-effective. Further studies should be conducted in order to evaluate effectiveness of liver cancer screening, and compare the cost effectiveness of different liver cancer screening programs with a final outcome indicator such as qualityadjusted life-years or disability-adjusted life-years.

Alcoholic liver disease in relation to cancer incidence and mortality: Findings from a large, matched cohort study in South Korea

“…Furthermore, there is evidence showing that the implementation of an HCC surveillance program enables the promotion of early stage diagnosis and curative treatment, and increases overall survival 5,34 . In Korea, the nationwide liver cancer screening program was initiated in 2003, 35 in which people aged 40 years or older with hepatitis B or C, liver cirrhosis, or chronic diseases of any cause (i.e., the high‐risk group) were eligible to participate 36 . The program's cost‐effectiveness and beneficial impact on the mortality rate have been proposed in high‐risk groups; 36 therefore, promising outcomes in terms of screening programs for patients with ALD can be anticipated.…”

Surveillance Rate and its Impact on Survival of Hepatocellular Carcinoma Patients in South Korea: A Cohort Study

“…In contrast, a community based randomized study reported that there was no significant difference in the overall survival between 4- and 12-month US surveillance interval for patients with chronic viral hepatitis and thrombocytopenia [29]. A recent cost-effectiveness study proposed that the most optimal surveillance strategy is an initial screening age of 50 years old with a 1-year inter-screening interval [30]. Although it was shown as Supplementary data, our study also showed that the observed survival of HCC patients who undertook surveillance studies within 6-months interval and those with 6- to 12-month interval were not significantly different.…”

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

“…49 Twenty-three studies focused on patients with cirrhosis: 6 on HBV carriers, [50][51][52][53][54][55] and 14 on populations with different liver diseases (cirrhotic or noncirrhotic chronic HBV and HCV, nonalcoholic steatohepatitis, or fibrosis). 48,[56][57][58][59][60][61][62][63][64][65][66][67][68] Markov-modeling studies mostly used lifetime horizons, 48,52,53,63,64,[69][70][71][72][73][74][75][76][77][78] with 4 applying horizons of 10 to 25 years, 62,79-81 1 of 30 years (for 40-year-old patients), 82 and 1 of between 15 to 50 years for patients of different ages (30,40, and 50 years old). 66 The horizon was not reported in four modeling studies.…”

“…48,[56][57][58][59][60][61][62][63][64][65][66][67][68] Markov-modeling studies mostly used lifetime horizons, 48,52,53,63,64,[69][70][71][72][73][74][75][76][77][78] with 4 applying horizons of 10 to 25 years, 62,79-81 1 of 30 years (for 40-year-old patients), 82 and 1 of between 15 to 50 years for patients of different ages (30,40, and 50 years old). 66 The horizon was not reported in four modeling studies. 51,54,68,83 Discount rates were reported in all Markov-modeling studies; a single study applied discounting for both costs and outcomes but did not report the rate used.…”