Cost‐effectiveness of the surveillance program of hepatocellular carcinoma depends on the medical circumstances

Nouso, Kazuhiro; Tanaka, Hironori; Uematsu, Setsuko; Shiraga, Kunihiro; Okamoto, Ryoichi; Onishi, Hideki; Nakamura, Shin; Kobayashi, Yohnosuke; Araki, Yoshihiro; Aoki, Noriaki; Shiratori, Yasushi

doi:10.1111/j.1440-1746.2007.05054.x

Cited by 51 publications

(32 citation statements)

References 52 publications

(109 reference statements)

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“…A modelled surveillance programs for HCC in Japan found an ICER of $US 29,900 per QALY gained, when assuming no clinical diagnosis of disease (i.e. earlier diagnosis), compared to $US 35,400 per QALY gained, assuming that 20% of HCC were detected clinically [41]. Our modelled costeffectiveness ratio is substantially higher than these reported results, primarily because previous analyses modelled costs and effects of HCC surveillance in patients with existing cirrhosis.…”

Section: Discussioncontrasting

confidence: 68%

“…Programs of twice-yearly surveillance of patients with cirrhosis for HCC using AFP and ultrasound [30,[39][40][41][42] found ICERs ranging from $US 26,689 per QALY gained [39] to $US 73,789 USD per QALY gained [40]. However, direct comparisons of cost-effectiveness are not appropriate, due to substantial differences in the patient populations modelled, the comparators used in the analyses, variations in health system structure, health care funding, and clinical practice, including the use of transplantation.…”

Section: Discussionmentioning

confidence: 99%

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Antiviral therapy for hepatitis B-related liver cancer prevention is more cost-effective than cancer screening

Robotin

Kansil

Howard

et al. 2009

Journal of Hepatology

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Section: Discussioncontrasting

confidence: 68%

Section: Discussionmentioning

confidence: 99%

Antiviral therapy for hepatitis B-related liver cancer prevention is more cost-effective than cancer screening

Robotin

Kansil

Howard

et al. 2009

Journal of Hepatology

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“…HCC surveillance requires facilities and manpower resources and may not be cost-effective in patients at low risk of HCC [10]. With this background, several Asian groups have derived and validated HCC risk scores based on well-known risk factors to predict future HCC development in patients with chronic hepatitis B.…”

Section: Chronic Hepatitis B Virus (Hbv) Infection Affects Over 350 Mmentioning

confidence: 99%

Can we use HCC risk scores to individualize surveillance in chronic hepatitis B infection?

Wong

Janssen

2015

Journal of Hepatology

104

111

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Chronic hepatitis B is one of the leading causes of hepatocellular carcinoma (HCC) worldwide. Accurate prediction of HCC risk is important for decisions on antiviral therapy and HCC surveillance. In the last few years, a number of Asian groups have derived and validated several HCC risk scores based on well-known risk factors such as cirrhosis, age, male sex and high viral load. Overall, these scores have high negative predictive values of over 95% in excluding HCC development in 3 to 10 years. The REACH-B score was derived from a community cohort of non-cirrhotic patients and is better applied in the primary care setting. In contrast, the GAG-HCC and CU-HCC scores were derived from hospital cohorts and include cirrhosis as a major integral component. While the latter scores may be more applicable to patients at specialist clinics, the diagnosis of cirrhosis based on routine imaging and clinical parameters can be inaccurate. To this end, recent developments in non-invasive tests of liver fibrosis may further refine the risk prediction. The application of HCC risk scores in patients on antiviral therapy and in other ethnic groups should be evaluated in future studies.

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“…For hepatitis B, surveillance becomes cost effective if the incidence exceeds about 0.2%/year (J. Collier and M. Sherman, unpublished observations, 1996). For cirrhosis from other causes, surveillance becomes cost effective if the incidence exceeds 1.5% to 2%/year [10,11].…”

Section: Assessment Of Hcc Riskmentioning

confidence: 99%

Modern Approach to Hepatocellular Carcinoma

Sherman

2010

Curr Gastroenterol Rep

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Hepatocellular carcinoma (HCC) used to be considered a universally fatal disease. Today, however, we have tools to identify patients at risk for HCC with more accuracy. We are able to provide surveillance using ultrasonography that is sufficiently sensitive to detect small HCC lesions. Treatment of these lesions, whether by resection or by radiofrequency ablation, is highly effective. These advances mean that HCC is theoretically curable in the majority of patients, provided these tools are used. Microarray technology has been applied to the study of the genetic changes in HCC, and has defined several distinct genetic variants of this disease, as well as identifying gene signatures that predict poor outcome, and predict metastases. These techniques are now being used to identify new potential targets for therapy, and hold great promise for the future.

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Cost‐effectiveness of the surveillance program of hepatocellular carcinoma depends on the medical circumstances

Abstract: The gain in QALYs and the ICER due to the surveillance of HCC varies between different patient subgroups and it critically depends on the rate of small HCC detected incidentally without surveillance, as well as the annual incidence of HCC and the adoption of liver transplantation.

Cited by 51 publications

References 52 publications

Antiviral therapy for hepatitis B-related liver cancer prevention is more cost-effective than cancer screening

Antiviral therapy for hepatitis B-related liver cancer prevention is more cost-effective than cancer screening

Can we use HCC risk scores to individualize surveillance in chronic hepatitis B infection?

Modern Approach to Hepatocellular Carcinoma

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