Abstract
Background and Aim: The clinical features of hepatocellular carcinoma (HCC) and the medical environment are diverse in different geographic areas. The aim of this study is to evaluate the cost-effectiveness of the surveillance of HCC in different medical circumstances. Methods: The Markov model focused on variables that differ from country to country and may change in the future, especially in regards to the proportion of small HCC detected incidentally. The target population was 45-year-old patients with Child-Pugh class A cirrhosis, and the intervention was surveillance with ultrasonography every 6 months. Results: The additional cost of the surveillance was $US15 100, the gain in quality-adjusted life years (QALYs) was 0.50 years, and the incremental cost-effectiveness ratio (ICER) was $US29 900/QALY in a base-case analysis (annual incidence of HCC = 4%). If 40% of small HCC were detected incidentally without surveillance, the gain in QALY decreased to 0.15 and the ICER increased to $US47 900/QALY. The increase in the annual incidence of HCC to 8% resulted in the increase of QALYs to 0.81, and the decrease of the ICER to $US25 400/QALY. The adoption of liver transplantation increased the gain in QALYs and the ICER to 0.84 and $US59 900/QALY, respectively. Conclusions: The gain in QALYs and the ICER due to the surveillance of HCC varies between different patient subgroups and it critically depends on the rate of small HCC detected incidentally without surveillance, as well as the annual incidence of HCC and the adoption of liver transplantation.
| Original language | English |
|---|---|
| Pages (from-to) | 437-444 |
| Number of pages | 8 |
| Journal | Journal of Gastroenterology and Hepatology (Australia) |
| Volume | 23 |
| Issue number | 3 |
| DOIs | |
| Publication status | Published - 2008 |
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Keywords
- Cancer
- Liver
- Markov model
- Quality-adjusted life year
- Screening
ASJC Scopus subject areas
- Gastroenterology
- Hepatology
Cite this
Cost-effectiveness of the surveillance program of hepatocellular carcinoma depends on the medical circumstances. / Nouso, Kazuhiro; Tanaka, Hironori; Uematsu, Shuji; Shiraga, Kunihiro; Okamoto, Ryoichi; Ohnishi, Hideki; Nakamura, Shin Ichiro; Kobayashi, Yoshiyuki; Araki, Yasuyuki; Aoki, Noriaki; Shiratori, Yasushi.
In: Journal of Gastroenterology and Hepatology (Australia), Vol. 23, No. 3, 2008, p. 437-444.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Cost-effectiveness of the surveillance program of hepatocellular carcinoma depends on the medical circumstances
AU - Nouso, Kazuhiro
AU - Tanaka, Hironori
AU - Uematsu, Shuji
AU - Shiraga, Kunihiro
AU - Okamoto, Ryoichi
AU - Ohnishi, Hideki
AU - Nakamura, Shin Ichiro
AU - Kobayashi, Yoshiyuki
AU - Araki, Yasuyuki
AU - Aoki, Noriaki
AU - Shiratori, Yasushi
PY - 2008
Y1 - 2008
N2 - Background and Aim: The clinical features of hepatocellular carcinoma (HCC) and the medical environment are diverse in different geographic areas. The aim of this study is to evaluate the cost-effectiveness of the surveillance of HCC in different medical circumstances. Methods: The Markov model focused on variables that differ from country to country and may change in the future, especially in regards to the proportion of small HCC detected incidentally. The target population was 45-year-old patients with Child-Pugh class A cirrhosis, and the intervention was surveillance with ultrasonography every 6 months. Results: The additional cost of the surveillance was $US15 100, the gain in quality-adjusted life years (QALYs) was 0.50 years, and the incremental cost-effectiveness ratio (ICER) was $US29 900/QALY in a base-case analysis (annual incidence of HCC = 4%). If 40% of small HCC were detected incidentally without surveillance, the gain in QALY decreased to 0.15 and the ICER increased to $US47 900/QALY. The increase in the annual incidence of HCC to 8% resulted in the increase of QALYs to 0.81, and the decrease of the ICER to $US25 400/QALY. The adoption of liver transplantation increased the gain in QALYs and the ICER to 0.84 and $US59 900/QALY, respectively. Conclusions: The gain in QALYs and the ICER due to the surveillance of HCC varies between different patient subgroups and it critically depends on the rate of small HCC detected incidentally without surveillance, as well as the annual incidence of HCC and the adoption of liver transplantation.
AB - Background and Aim: The clinical features of hepatocellular carcinoma (HCC) and the medical environment are diverse in different geographic areas. The aim of this study is to evaluate the cost-effectiveness of the surveillance of HCC in different medical circumstances. Methods: The Markov model focused on variables that differ from country to country and may change in the future, especially in regards to the proportion of small HCC detected incidentally. The target population was 45-year-old patients with Child-Pugh class A cirrhosis, and the intervention was surveillance with ultrasonography every 6 months. Results: The additional cost of the surveillance was $US15 100, the gain in quality-adjusted life years (QALYs) was 0.50 years, and the incremental cost-effectiveness ratio (ICER) was $US29 900/QALY in a base-case analysis (annual incidence of HCC = 4%). If 40% of small HCC were detected incidentally without surveillance, the gain in QALY decreased to 0.15 and the ICER increased to $US47 900/QALY. The increase in the annual incidence of HCC to 8% resulted in the increase of QALYs to 0.81, and the decrease of the ICER to $US25 400/QALY. The adoption of liver transplantation increased the gain in QALYs and the ICER to 0.84 and $US59 900/QALY, respectively. Conclusions: The gain in QALYs and the ICER due to the surveillance of HCC varies between different patient subgroups and it critically depends on the rate of small HCC detected incidentally without surveillance, as well as the annual incidence of HCC and the adoption of liver transplantation.
KW - Cancer
KW - Liver
KW - Markov model
KW - Quality-adjusted life year
KW - Screening
UR - http://www.scopus.com/inward/record.url?scp=40349091830&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=40349091830&partnerID=8YFLogxK
U2 - 10.1111/j.1440-1746.2007.05054.x
DO - 10.1111/j.1440-1746.2007.05054.x
M3 - Article
C2 - 17683496
AN - SCOPUS:40349091830
VL - 23
SP - 437
EP - 444
JO - Journal of Gastroenterology and Hepatology (Australia)
JF - Journal of Gastroenterology and Hepatology (Australia)
SN - 0815-9319
IS - 3
ER -