Evidence-Based Medicine
Copyright ©The Author(s) 2016.
World J Gastroenterol. Mar 28, 2016; 22(12): 3460-3470
Published online Mar 28, 2016. doi: 10.3748/wjg.v22.i12.3460
Table 1 Base-case estimates and ranges used in sensitivity analysis
VariablesBase-caseDistribution of probabilistic sensitivity analysisRef.
Natural history and prognosis, per year
Prevalence of cirrhosis1.77%Β (1069, 59257)[23]
Annual transition rates
HCC incidence (1/yr)NCCirrhosisNCCirrhosis
30-39 yr0.000120.0024Gamma (0.06, 510)Gamma (0.23, 96)[2,10,23]
40-49 yr0.000360.0070Gamma (0.33, 1190)Gamma (1.2, 220)
50-59 yr0.001000.0200Gamma (3.07, 3614)Gamma (10, 632)
60-69 yr0.002100.0410Gamma (19, 8928)Gamma (67, 1640)
70-79 yr0.004300.0820Gamma (79, 18280)Gamma (269, 3280)
PHCC to CHCC (Non-cirrhosis)0.376 (0.157- 0.595)Gamma (11.3, 30.1)[10,15]
PHCC to CHCC (Cirrhosis )0.637 (0.21-1.06)Gamma (8.7, 13.6)
CHCC to HCC death1.05 (0.93-1.18)Gamma (1.14, 1.09)
Age-specific mortality rate of cirrhosis
30-39 yr0.0046Gamma (0.2, 49.4)[2,16-19]
40-49 yr0.0086Gamma (0.8, 92.3)
50-59 yr0.0170Gamma (3.1, 182.4)
60-69 yr0.0380Gamma (15.5, 407.7)
70-79 yr0.0980Gamma (103, 1051.5)
Survival rate of surveillance-detected PHCC (%)75Gamma (11.2, 15.8)[15]
First-stage 5 markers screening characteristics
Attendance rate (%)60Β (23654, 18733)[9,13,24]
Sensitivity to Cirrhosis (%)80Β (62, 15)[20]
Sensitivity to HCC95Β (50, 1)[13]
Specificity to HCC70Β (9493, 4282)[13]
Second-stage ultrasonography screening characteristics
Compliance rate of ultrasonography (%)80Β (16394, 3212)[9,13,24]
Sensitivity to cirrhosis (%)75Β (11, 3)[21]
Sensitivity to HCC (%)83Β (48, 10)[9,12,22]
Specificity to HCC (%)97Β (20137, 637)[9,12,22]
Direct cost (USD)
Biochemical test
HBsAg4.7BNHI
HCVAb7.4BNHI
GOT1.5BNHI
GPT1.5BNHI
AFP5.9BNHI
Ultrasonography26BNHI
Confirmation (USD)
Triple-phase abdominal CT148BNHI
Ultrasonic guidance for biopsy38.3BNHI
Liver puncture36BNHI
Specimen examinations of pathology51.2BNHI
Treatment (USD)
Initial cost of HCC treatment4892Lognormal (8.28, 0.53)NTUH
Continuing cost of HCC treatment4266Lognormal (8.18, 0.46)NTUH
Incurable-cancer care (average)5691Lognormal (8.36, 0.81)NTUH
Indirect cost (USD)
Screening time (h)0.5[10,26]
Person accompanied for screening0[10,26]
Time spent for ultrasonography4[10,26]
Confirmation time (h)8NTUH, [26]
Person accompanied for confirmation1NTUH, [26]
Inpatient hospitalization (d)15NTUH
Inpatient recovered at home (d)15[26]
Person accompanied for inpatient care1.69[26]
Outpatient time per visit (h)4[26]
Outpatient visit per year9.7NTUH
Patient accompanied for outpatient visit0.77[26]
Inpatient of terminal care (d)30NTUH
Person accompanied for terminal care1[26]
Average work per month (h)184DGBAS
Production value per hour (USD)7.6DGBAS
Discount rate (%)3
Table 2 Simulated results for screening strategies to prevent hepatocellular carcinoma
OutcomeNo interventionTwo-stage screeningMass screening using ultrasonography
Cost per individual screened, USD275533893359
Life-year gain1 (yr)20.479820.492620.4950
Comparing with ICER
No screening as reference-4973339825
Two-stage screening as reference--Dominant2