Hepatocellular carcinoma surveillance based on the Australian Consensus Guidelines: a health economic modelling study

BMC Health Services Research

卷:23

Research

John S Lubel¹  Anh Le Tuan Nguyen²  Andrew John Palmer²  Christopher Leigh Blizzard²  Barbara de Graaff²  Jane Bradshaw³  Kerry Hardy³  Lei Si⁴  Mark Wilson⁵  Kwang Chien Yee⁵  Nicholas Shackel⁶ 

[1] Alfred Health, Melbourne, VIC, Australia;Monash University, Melbourne, VIC, Australia;

[2] Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, 7000, Hobart, TAS, Australia;

[3] Royal Hobart Hospital, Hobart, TAS, Australia;

[4] School of Health Sciences, Western Sydney University, Campbelltown, Australia;Translational Health Research Institute, Western Sydney University, Penrith, Australia;

[5] School of Medicine, University of Tasmania, Hobart, TAS, Australia;Royal Hobart Hospital, Hobart, TAS, Australia;

[6] University of New South Wales, Sydney, NSW, Australia;

关键词: Hepatocellular carcinoma;    Surveillance;    Cost-effectiveness;    Ultrasound;    Alpha-fetoprotein;   

DOI  :  10.1186/s12913-023-09360-4

 received in 2022-08-29, accepted in 2023-03-31,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundHepatocellular carcinoma (HCC) is the fastest increasing cause of cancer death in Australia. A recent Australian consensus guidelines recommended HCC surveillance for cirrhotic patients and non-cirrhotic chronic hepatitis B (CHB) patients at gender and age specific cut-offs. A cost-effectiveness model was then developed to assess surveillance strategies in Australia.MethodsA microsimulation model was used to evaluate three strategies: biannual ultrasound, biannual ultrasound with alpha-fetoprotein (AFP) and no formal surveillance for patients having one of the conditions: non-cirrhotic CHB, compensated cirrhosis or decompensated cirrhosis. One-way and probabilistic sensitivity analyses as well as scenario and threshold analyses were conducted to account for uncertainties: including exclusive surveillance of CHB, compensated cirrhosis or decompensated cirrhosis populations; impact of obesity on ultrasound sensitivity; real-world adherence rate; and different cohort’s ranges of ages.ResultsSixty HCC surveillance scenarios were considered for the baseline population. The ultrasound + AFP strategy was the most cost-effective with incremental cost-effectiveness ratios (ICER) compared to no surveillance falling below the willingness-to-pay threshold of A$50,000 per quality-adjusted life year (QALY) at all age ranges. Ultrasound alone was also cost-effective, but the strategy was dominated by ultrasound + AFP. Surveillance was cost-effective in the compensated and decompensated cirrhosis populations alone (ICERs < $30,000), but not cost-effective in the CHB population (ICERs > $100,000). Obesity could decrease the diagnostic performance of ultrasound, which in turn, reduce the cost-effectiveness of ultrasound ± AFP, but the strategies remained cost-effective.ConclusionsHCC surveillance based on Australian recommendations using biannual ultrasound ± AFP was cost-effective.

【 授权许可】

CC BY   
© The Author(s) 2023

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