Performing ultrasound once every 6 months is the most cost-effective way to screen for hepatocellular carcinoma in patients with cirrhosis, according to data presented at the International Liver Cancer Association Annual Conference in Washington, DC.
Researchers performed a systematic review of 12 studies published in eight countries that assessed the cost-effectiveness of various screening methods for hepatocellular carcinoma (HCC) among patients with cirrhosis via Markov model. Evaluated methods included ultrasound (US) and contrast-enhanced ultrasound (CEUS), alpha-fetoprotein (AFP), computed tomography (CT) and MRI, with a screening frequency ranging from 3 to 12 months. Incremental cost-effectiveness ratios (ICER) per gained life year were calculated according to the gross domestic product (GDP) of the country of study origin during 2012.
Compared with no screening, investigators determined that US was cost-effective when performed every 6 months on its own (ICER=0.16 GDP per capita) or with AFP (ICER=0.63 GDP per capita), as well as every 12 months with AFP (ICER=0.54 GDP per capita). CEUS per 6 months (ICER=0.17 per capita) and CT with AFP per 6 months (ICER=0.6 GDP per capita) also were considered cost-effective. Single-arm meta-analysis on probability variables indicated significant uncertainty in detecting HCC smaller than 3 cm, as well as the annual probability of HCC growth following transarterial embolization, via CEUS.
Univariate analysis incorporating ICER per gained quality-adjusted life year indicated a significant association between screening cost-effectiveness and a screening frequency of 6 months (coefficient=1.919; P=.002). Investigators also noted a nonsignificant association between HCC recurrence and screening cost-effectiveness (coefficient=41.899; P=.357).
“Applying US every 6 months to cirrhotic patients for HCC screening is the most cost-effective strategy, according to current economic evidence,” the researchers concluded. “Preventing HCC recurrence could substantially improve the cost-effectiveness of image methods-based screening for HCC in cirrhotic patients.”
Disclosure: The researchers report no relevant financial disclosures.
For more information:
Xiong Z. O-020: Cost-effectiveness of Image-based Screening Methods for Hepatocellular Carcinoma in Cirrhotic Patients: A Systematic Review. Presented at: The International Liver Cancer Association Annual Conference 2013; Sept. 13-15, Washington, DC.