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PMID: 18848905 Published · ppublish English Comparative Study Journal Article

Cost effectiveness of alternative surveillance strategies for hepatocellular carcinoma in patients with cirrhosis.

Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association ·Vol. 6 ·No. 12 ·2008-12-00 ·Pages 1418-24

Andersson KL, Salomon JA, Goldie SJ, Chung RT

Abstract

The increasing incidence of hepatocellular carcinoma (HCC) in the United States has significant health and economic consequences. Ultrasound (US) surveillance is recommended for patients with cirrhosis because of their high risk of HCC and improving treatment outcomes for small tumors. We assessed the costs, clinical benefits, and cost effectiveness of US surveillance and alternative strategies for HCC in cirrhosis using a computer-based state transition model with parameters derived from available literature. Our model compared a policy of no surveillance with 6 surveillance strategies in cirrhotic patients ages 50 years and older in the United States: (1) annual US, (2) semiannual US, (3) semiannual US with alpha-fetoprotein, (4) annual computed tomography (CT), (5) semiannual CT, and (6) annual magnetic resonance imaging. The number of screening tests needed to detect one small HCC, cost per treated HCC, lifetime costs, quality-adjusted life expectancy, and incremental cost-effectiveness ratios were calculated. Semiannual US surveillance for HCC in cirrhosis increased quality-adjusted life expectancy by 8.6 months on average, but extended it nearly 3.5 years in patients with small treated tumors. Semiannual US surveillance had an incremental cost-effectiveness ratio of $30,700 per quality-adjusted life year (QALY) gained, and was more cost effective than the alternative surveillance strategies using a threshold of $50,000 per QALY gained. The incremental cost-effectiveness ratios for the combined alpha-fetoprotein/US and annual CT strategies exceeded $50,000/QALY unless the sensitivity and specificity of US decreased to less than 65% and 60%, respectively. Semiannual US surveillance for HCC in cirrhotic patients improves clinical outcomes at a reasonable cost.

MeSH Terms
Aged Aged, 80 and over Carcinoma, Hepatocellular/diagnosis,economics Computer Simulation Cost-Benefit Analysis Diagnostic Techniques and Procedures/economics Fibrosis/complications Health Care Costs Humans Middle Aged Quality of Life United States
Authors & Affiliations
4 authors, click to expand affiliations / ORCID
Andersson Karin L
Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, USA. kandersson@partners.org
Salomon Joshua A
Goldie Sue J
Chung Raymond T
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Article Info
Journal
Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association
Abbr.
Clin Gastroenterol Hepatol
ISSN
1542-7714
DOI
10.1016/j.cgh.2008.08.005
Email
kandersson@partners.org
Published
2008-12-00
Epub
2008-00-19
Pages
1418-24
Language
English
Region
United States
NLM ID
101160775
PMCID
PMC4340842
Subset
IM
Grants
NIDDK NIH HHS · K24 DK078772 · United States
NIDDK NIH HHS · T32 DK007191 · United States
External Links
PubMed source DOI: 10.1016/j.cgh.2008.08.005 PMC Full Text View journal details
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