A Systematic Review and Narrative Synthesis of Health Economic Evaluations of Hepatocellular Carcinoma Screening Strategies.

Autor: Nguyen ALT; Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia., Nguyen HTT; Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia., Yee KC; School of Medicine, University of Tasmania, Hobart, Tasmania, Australia., Palmer AJ; Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia; Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia., Blizzard CL; Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia., de Graaff B; Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia. Electronic address: barbara.degraaff@utas.edu.au.
Jazyk: angličtina
Zdroj: Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research [Value Health] 2021 May; Vol. 24 (5), pp. 733-743. Date of Electronic Publication: 2021 Mar 05.
DOI: 10.1016/j.jval.2020.11.014
Abstrakt: Objectives: Many economic evaluations of hepatocellular carcinoma (HCC) screenings have been conducted; however, these vary substantially with regards to screening strategies, patient group, and setting. This review aims to report the current knowledge of the cost-effectiveness of screening and describe the published data.
Methods: We conducted a search of biomedical and health economic databases up to July 2020. We included full and partial health economic studies if they evaluated the costs or outcomes of HCC screening strategies.
Results: The review included 43 studies. Due to significant heterogeneity in key aspects across the studies, a narrative synthesis was conducted. Most studies reported using ultrasound or alpha fetoprotein as screening strategies. Screening intervals were mostly annual or biannual. Incidence, diagnostic performance, and health state utility values were the most critical parameters affecting the cost-effectiveness of screening. The majority of studies reported HCC screening to be cost-effective, with the biannual ultrasound + alpha fetoprotein standing out as the most cost-effective strategy. However, few studies considered the utilization rate, and none considered the diagnostic performance of ultrasound in the context of central adiposity. Computed tomography and magnetic resonance imaging were also evaluated, but its cost-effectiveness was still controversial.
Conclusions: Although many studies suggested HCC screening was cost-effective, substantial limitations of the quality of these studies means the results should be interpreted with caution. Future modeling studies should consider the impact of central adiposity on the precision of ultrasound, real-world utilization rates and projections of increased HCC incidence.
(Copyright © 2021 ISPOR–The Professional Society for Health Economics and Outcomes Research. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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