The Impact of National Surveillance for Liver Cancer: Results from Real-World Setting in Korea

Abstract

Background/Aims: The National Liver Cancer Surveillance Program (NLCSP) was established in 2003 to reduce the socioeconomic burden imposed by liver cancer (LC). We aimed to investigate the effectiveness of the NLCSP in South Korea with respect to survival benefits and cost, after adjusting for various confounding factors. Methods: We used the National Health Insurance Service claims data linked with the NLCSP from 2004 to 2015. The Cox proportional hazard model and generalized linear model were used to determine the effects of the NLCSP on the early detection of LC, survival, and medical costs. Results: From 2006 to 2010, 66,632 patients (surveillance group: 10,527 and no surveillance group: 56,105) newly diagnosed with LC were included in the study. The odds of the early detection of LC was 1.82 (95% confidence interval [CI], 1.73 to 1.93) times higher among patients who participated in the NLCSP once within the 2-year period prior to the diagnosis of LC than among those who did not participate in the surveillance program. The mortality rate of patients who participated in the NLCSP was 22.0% lower (hazard ratio, 0.78; 95% CI, 0.76 to 0.80) than that of those who did not participate. When compared with the group who did not participate in surveillance, the group who participated in the NLCSP had higher total medical costs; however, their cost per day was lower after adjustment during the follow-up period. Conclusions: This study highlights the survival benefit in patients who participated in the NLCSP and the need for continuous improvements of the NLCSP in South Korea. (Gut Liver 2020;14:108-116) This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

A Survey of Liver Cancer Specialists’ Views on the National Liver Cancer Screening Program in Korea

“…Assessment of the needs for improvement in certain areas of the National Liver Cancer Screening Program according to survey participants.among patients who participated in the NLCSP once within two years prior to the diagnosis of liver cancer compared to those who did not participate in the NLCSP,8 indicating the potential role of the NLCSP in reducing HCC-related mortality. However, other studies reported poor efficacy of the NLCSP.…”

Association between new-onset liver cirrhosis and suicide risk in South Korea: A nationwide cohort study

“…The decompensated LC cohort comprised those with K702, K703, K717, K74, K761, K765, K766 codes accompanying I85.0, I86.4, I98.3, K72, K72.1, K72.9, K76.7, R17, R18 codes, and the alcoholic cirrhosis cohort was defined as patients with simultaneous codes of K70.2 and K70.3. For definition of the ICD-10 code for LC patient groups, validation studies and a South Korean study were referenced [ 17 - 20 ]. Among these patients, some were excluded to maintain the study design validity.…”

“…The incident LC cohort was constructed from the NHIS-NSC base cohort. To be enrolled, subjects must fit the operational definition of new-onset LC, i.e., first-time admission to an acute care hospital or two or more outpatient visits with primary or the first secondary [17][18][19][20] . Among these patients, some were excluded to maintain the study design validity.…”

Effectiveness of Hepatocellular Carcinoma Surveillance and an Optimal Surveillance Interval: Nationwide Cohort of Korea

“…To date, several studies have been conducted to evaluate the effectiveness of the surveillance program, and most of them have covered data from a single institution. 17 18 19 20 In this study, we analyzed associations between surveillance intervals and the rates of receiving curative treatment and mortality to evaluate the effectiveness of the national HCC surveillance program using nationwide cohort data.…”