Published online Mar 28, 2016. doi: 10.3748/wjg.v22.i12.3460
Peer-review started: August 3, 2015
First decision: September 9, 2015
Revised: September 29, 2015
Accepted: December 19, 2015
Article in press: December 21, 2015
Published online: March 28, 2016
Processing time: 236 Days and 2.4 Hours
AIM: To assess the cost-effectiveness of two population-based hepatocellular carcinoma (HCC) screening programs, two-stage biomarker-ultrasound method and mass screening using abdominal ultrasonography (AUS).
METHODS: In this study, we applied a Markov decision model with a societal perspective and a lifetime horizon for the general population-based cohorts in an area with high HCC incidence, such as Taiwan. The accuracy of biomarkers and ultrasonography was estimated from published meta-analyses. The costs of surveillance, diagnosis, and treatment were based on a combination of published literature, Medicare payments, and medical expenditure at the National Taiwan University Hospital. The main outcome measure was cost per life-year gained with a 3% annual discount rate.
RESULTS: The results show that the mass screening using AUS was associated with an incremental cost-effectiveness ratio of USD39825 per life-year gained, whereas two-stage screening was associated with an incremental cost-effectiveness ratio of USD49733 per life-year gained, as compared with no screening. Screening programs with an initial screening age of 50 years old and biennial screening interval were the most cost-effective. These findings were sensitive to the costs of screening tools and the specificity of biomarker screening.
CONCLUSION: Mass screening using AUS is more cost effective than two-stage biomarker-ultrasound screening. The most optimal strategy is an initial screening age at 50 years old with a 2-year inter-screening interval.
Core tip: Hepatocellular carcinoma (HCC) mortality could be reduced by early detection. Previous studies have investigated the cost-effectiveness of different surveillance intervals and screening modalities but were restricted to high risk populations. We conducted a cost-effectiveness analysis of mass screening for HCC with abdominal ultrasonography for the general population and compared it to the existing two-stage biomarker-ultrasound screening in an area with high HCC incidence. The findings suggest early detection of HCC with abdominal ultrasonography may be useful for the general population in an area with high HCC incidence not covered by hepatitis B vaccination.