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

Autor: Nguyen ALT; Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, TAS, 7000, Australia. al.nguyen@utas.edu.au., Si L; School of Health Sciences, Western Sydney University, Campbelltown, Australia.; Translational Health Research Institute, Western Sydney University, Penrith, Australia., Lubel JS; Alfred Health, Melbourne, VIC, Australia.; Monash University, Melbourne, VIC, Australia., Shackel N; University of New South Wales, Sydney, NSW, Australia., Yee KC; School of Medicine, University of Tasmania, Hobart, TAS, Australia.; Royal Hobart Hospital, Hobart, TAS, Australia., Wilson M; School of Medicine, University of Tasmania, Hobart, TAS, Australia.; Royal Hobart Hospital, Hobart, TAS, Australia., Bradshaw J; Royal Hobart Hospital, Hobart, TAS, Australia., Hardy K; Royal Hobart Hospital, Hobart, TAS, Australia., Palmer AJ; Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, TAS, 7000, Australia., Blizzard CL; Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, TAS, 7000, Australia., de Graaff B; Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, TAS, 7000, Australia.
Jazyk: angličtina
Zdroj: BMC health services research [BMC Health Serv Res] 2023 Apr 19; Vol. 23 (1), pp. 378. Date of Electronic Publication: 2023 Apr 19.
DOI: 10.1186/s12913-023-09360-4
Abstrakt: Background: Hepatocellular 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.
Methods: A 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.
Results: Sixty 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.
Conclusions: HCC surveillance based on Australian recommendations using biannual ultrasound ± AFP was cost-effective.
(© 2023. The Author(s).)
Databáze: MEDLINE
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