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

Background 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. Methods We de...

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Bibliographic Details
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: London BioMed Central 13.08.2024
BioMed Central Ltd
Springer Nature B.V
BMC
Subjects:
Ablation
Adult
Age
Aged
Barriers and facilitators to cancer screening
Biostatistics
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
Environmental Health
Epidemiology
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
Medicine
Medicine & Public Health
Methods
Microsimulation modeling
Middle Aged
Patients
Public Health
Quality-Adjusted Life Years
Radiation therapy
Remission
Remission (Medicine)
Risk factors
Risk groups
Screening
Simulation
Surveillance
Vaccine
China
United States > US
Liver cancer
Screening
Microsimulation modeling
Cost-effectiveness
ISSN:1471-2458, 1471-2458
Online Access:Get full text
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Summary:Background 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. Methods 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. Results 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. Conclusions 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. Lay summary The most cost-effective age group for surveillance of hepatocellular carcinoma (HCC) varied depending on the stage of the disease. Regular annual surveillance for patients with compensated cirrhosis or advanced fibrosis was more cost-effective option, showing great economic and clinical benefits with slightly less effective than biannual surveillance but significantly lower cost.
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ISSN:1471-2458
1471-2458
DOI:10.1186/s12889-024-19670-9