Economic evaluation of hepatocellular carcinoma surveillance in chronic hepatitis B patients with virological remission

• Published in: BMC public health Vol. 24; no. 1; pp. 2202 - 12
• Main Authors: Fang, Kailu, Li, Shuwen, Lin, Yushi, Zhang, Yu, Wu, Jie
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 13.08.2024; BioMed Central; BMC
• Subjects: Ablation; Adult; Age; Aged; Cancer; Cancer therapies; Carcinoma, Hepatocellular; Care and treatment; China - epidemiology; Cirrhosis; Cohort analysis; Cost analysis; Cost benefit analysis; Cost effectiveness; Development and progression; Diagnosis; Economic aspects; Economics; Female; Fibrosis; Hepatitis; Hepatitis B; Hepatitis B, Chronic - complications; Hepatocellular carcinoma; Hepatoma; Humans; Immunization; Liver; Liver cancer; Liver cirrhosis; Liver Cirrhosis - complications; Liver diseases; Liver Neoplasms; Liver transplants; Magnetic resonance imaging; Male; Medical prognosis; Methods; Microsimulation modeling; Middle Aged; Patients; Quality-Adjusted Life Years; Radiation therapy; Remission; Remission (Medicine); Risk factors; Risk groups; Screening; Simulation; Surveillance; China; United States > US; Liver cancer; Screening; Microsimulation modeling; Cost-effectiveness
• ISSN: 1471-2458; 1471-2458
• DOI: 10.1186/s12889-024-19670-9

Subsequent risk of hepatocellular carcinoma (HCC) persists in chronic hepatitis B (CHB) patients with virological remission. We aimed to assess the cost-effectiveness of HCC surveillance in those patients and determine appropriate age to commence or discontinue surveillance. We developed an individual-based state transition model, simulating the advancement of HCC in CHB patients with virological remission. We used this model to compare the incremental cost-effectiveness ratio (ICER) and long-term health outcomes of biannual or annual HCC surveillance for varying durations with no surveillance. For compensated cirrhosis patients with CHB, biannual surveillance was not cost-effective for all age groups, while annual surveillance was cost-effective for patients aged 55 to 70 (ICER USD 28,076 / quality-adjusted life years [QALY] gained), which detected 176 additional early HCC cases in a 100,000-person cohort compared to no surveillance. In CHB patients with advanced fibrosis, annual surveillance for patients aged 40 to 75 was the most cost-effective strategy (ICER USD 4,984/QALY gained), which detected 289 additional early HCC per 100,000 patients. Annual surveillance for patients with compensated cirrhosis or advanced fibrosis was a more cost-effective option that demonstrated substantial economic benefits, being slightly less effective than biannual surveillance at a significantly lower cost, providing insights for professionals in evaluating HCC surveillance among high-risk patients in China.