Hepatocellular carcinoma (HCC) is a serious complication associated with chronic liver disease. Current guidelines recommended HCC surveillance using ultrasound (US) every six months. However, US surveillance can be challenging for some patients, particularly those with cirrhosis or obesity. Alternately, computed tomography (CT), magnetic resonance imaging (MRI), and abbreviated MRI have been explored as alternative imaging modalities and may be used in selected patients who are likely to have experienced inadequate US examinations. In this thesis, we aimed to assess the cost-effectiveness of imaging-based surveillance and diagnostic strategies in patients at risk of HCC while taking into account technically inadequate examinations and patients' compliance.