Cost-effectiveness of the surveillance program of hepatocellular carcinoma depends on the medical circumstances

Kazuhiro Nouso, Hironori Tanaka, Shuji Uematsu, Kunihiro Shiraga, Ryoichi Okamoto, Hideki Ohnishi, Shin Ichiro Nakamura, Yoshiyuki Kobayashi, Yasuyuki Araki, Noriaki Aoki, Yasushi Shiratori

Research output: Contribution to journalArticle

39 Citations (Scopus)

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 languageEnglish
Pages (from-to)437-444
Number of pages8
JournalJournal of Gastroenterology and Hepatology (Australia)
Volume23
Issue number3
DOIs
Publication statusPublished - 2008

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Quality-Adjusted Life Years
Cost-Benefit Analysis
Hepatocellular Carcinoma
Liver Transplantation
Incidence
Health Services Needs and Demand
Ultrasonography
Fibrosis
Costs and Cost Analysis

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 journalArticle

Nouso, K, Tanaka, H, Uematsu, S, Shiraga, K, Okamoto, R, Ohnishi, H, Nakamura, SI, Kobayashi, Y, Araki, Y, Aoki, N & Shiratori, Y 2008, 'Cost-effectiveness of the surveillance program of hepatocellular carcinoma depends on the medical circumstances', Journal of Gastroenterology and Hepatology (Australia), vol. 23, no. 3, pp. 437-444. https://doi.org/10.1111/j.1440-1746.2007.05054.x
Nouso, Kazuhiro ; Tanaka, Hironori ; Uematsu, Shuji ; Shiraga, Kunihiro ; Okamoto, Ryoichi ; Ohnishi, Hideki ; Nakamura, Shin Ichiro ; Kobayashi, Yoshiyuki ; Araki, Yasuyuki ; Aoki, Noriaki ; Shiratori, Yasushi. / Cost-effectiveness of the surveillance program of hepatocellular carcinoma depends on the medical circumstances. In: Journal of Gastroenterology and Hepatology (Australia). 2008 ; Vol. 23, No. 3. pp. 437-444.
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AU - Okamoto, Ryoichi

AU - Ohnishi, Hideki

AU - Nakamura, Shin Ichiro

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AU - Araki, Yasuyuki

AU - Aoki, Noriaki

AU - Shiratori, Yasushi

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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

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