Early-stage hepatocellular carcinoma screening in patients with chronic hepatitis B in China: a cost–effectiveness analysis
Aim: To evaluate the cost–effectiveness of seven screening strategies for chronic hepatitis B (CHB) patients in China. Methods: A discrete event simulation model combining a decision tree and Markov structure was developed to simulate a CHB cohort aged≥40 years on a lifetime horizon and evaluate t...
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| Format: | Article |
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Becaris Publishing Limited
2024-02-01
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| Series: | Journal of Comparative Effectiveness Research |
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| _version_ | 1797229448956739584 |
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| author | Yuemin Nan Department of Traditional & Western Medical Hepatology, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China Xianzhong Lu Yue Zhang Li Xie Zhongyi Niu Wen Chen |
| author_facet | Yuemin Nan Department of Traditional & Western Medical Hepatology, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China Xianzhong Lu Yue Zhang Li Xie Zhongyi Niu Wen Chen |
| author_sort | Yuemin Nan |
| collection | DOAJ |
| description | Aim: To evaluate the cost–effectiveness of seven screening strategies for chronic hepatitis B (CHB) patients
in China. Methods: A discrete event simulation model combining a decision tree and Markov structure was
developed to simulate a CHB cohort aged≥40 years on a lifetime horizon and evaluate the costs and health
outcomes (quality-adjusted life years [QALYs] gained) of ultrasonography (US), alpha-fetoprotein (AFP),
protein induced by vitamin K absence-II (PIVKA-II), AFP+US, AFP+PIVKA-II, GAAD (a diagnostic algorithm
based on gender and age combined with results of AFP and PIVKA-II) and GAAD+US. Epidemiologic,
clinical performance, utility and cost data were obtained from the literature, expert interviews and
real-world data. Uncertainties on key parameters were explored through deterministic and probabilistic
sensitivity analyses (DSA and PSA). Results: Compared with other strategies, GAAD+US detected the most
HCC patients at early stage, and GAAD was the screening strategy with the lowest average cost per HCC
case diagnosed. Using 3× China’s 2022 GDP per capita ($38,233.34) as the threshold, the three strategies
of US, GAAD and GAAD+US formed a cost–effectiveness frontier. Screening with US, GAAD, or GAAD+US
was associated with costs of $6110.46, $7622.05 and $8636.32, and QALYs of 13.18, 13.48 and 13.52,
respectively. The ICER of GAAD over US was $4993.39/QALY and the ICER of GAAD+US over GAAD was
$26,691.45/QALY, which was less than 3× GDP per capita. Both DSA and PSA proved the stability of the
results. Conclusion: GAAD+US was the most cost-effective strategy for early HCC diagnosis among CHB
patients which could be considered as the liver cancer screening scheme for the high-risk population in
China. |
| first_indexed | 2024-04-24T15:12:46Z |
| format | Article |
| id | doaj.art-68b31dab7bab441bbde6ae11c9aaf1c8 |
| institution | Directory Open Access Journal |
| issn | 2042-6313 |
| language | English |
| last_indexed | 2024-04-24T15:12:46Z |
| publishDate | 2024-02-01 |
| publisher | Becaris Publishing Limited |
| record_format | Article |
| series | Journal of Comparative Effectiveness Research |
| spelling | doaj.art-68b31dab7bab441bbde6ae11c9aaf1c82024-04-02T09:58:59ZengBecaris Publishing LimitedJournal of Comparative Effectiveness Research2042-63132024-02-0113410.57264/cer-2023-0146Early-stage hepatocellular carcinoma screening in patients with chronic hepatitis B in China: a cost–effectiveness analysisYuemin Nan0Department of Traditional & Western Medical Hepatology, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China1Xianzhong Lu2Yue Zhang3Li Xie4Zhongyi Niu5Wen Chen6Department of Traditional & Western Medical Hepatology, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, ChinaRoche Diagnostics International, Rotkreuz, ZG, SwitzerlandRoche Diagnostics (Shanghai) Co., Ltd, Shanghai, 200335, ChinaRoche Diagnostics (Shanghai) Co., Ltd, Shanghai, 200335, ChinaYidu Cloud (Beijing) Technology Co., Ltd, Beijing, 100083, ChinaYidu Cloud (Beijing) Technology Co., Ltd, Beijing, 100083, ChinaSchool of Public Health, Fudan University, Shanghai, 200032, ChinaAim: To evaluate the cost–effectiveness of seven screening strategies for chronic hepatitis B (CHB) patients in China. Methods: A discrete event simulation model combining a decision tree and Markov structure was developed to simulate a CHB cohort aged≥40 years on a lifetime horizon and evaluate the costs and health outcomes (quality-adjusted life years [QALYs] gained) of ultrasonography (US), alpha-fetoprotein (AFP), protein induced by vitamin K absence-II (PIVKA-II), AFP+US, AFP+PIVKA-II, GAAD (a diagnostic algorithm based on gender and age combined with results of AFP and PIVKA-II) and GAAD+US. Epidemiologic, clinical performance, utility and cost data were obtained from the literature, expert interviews and real-world data. Uncertainties on key parameters were explored through deterministic and probabilistic sensitivity analyses (DSA and PSA). Results: Compared with other strategies, GAAD+US detected the most HCC patients at early stage, and GAAD was the screening strategy with the lowest average cost per HCC case diagnosed. Using 3× China’s 2022 GDP per capita ($38,233.34) as the threshold, the three strategies of US, GAAD and GAAD+US formed a cost–effectiveness frontier. Screening with US, GAAD, or GAAD+US was associated with costs of $6110.46, $7622.05 and $8636.32, and QALYs of 13.18, 13.48 and 13.52, respectively. The ICER of GAAD over US was $4993.39/QALY and the ICER of GAAD+US over GAAD was $26,691.45/QALY, which was less than 3× GDP per capita. Both DSA and PSA proved the stability of the results. Conclusion: GAAD+US was the most cost-effective strategy for early HCC diagnosis among CHB patients which could be considered as the liver cancer screening scheme for the high-risk population in China.chronic hepatitis bcost–effectiveness analysishepatocellular carcinomascreening |
| spellingShingle | Yuemin Nan Department of Traditional & Western Medical Hepatology, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China Xianzhong Lu Yue Zhang Li Xie Zhongyi Niu Wen Chen Early-stage hepatocellular carcinoma screening in patients with chronic hepatitis B in China: a cost–effectiveness analysis Journal of Comparative Effectiveness Research chronic hepatitis b cost–effectiveness analysis hepatocellular carcinoma screening |
| title | Early-stage hepatocellular carcinoma screening in patients with chronic hepatitis B in China: a cost–effectiveness analysis |
| title_full | Early-stage hepatocellular carcinoma screening in patients with chronic hepatitis B in China: a cost–effectiveness analysis |
| title_fullStr | Early-stage hepatocellular carcinoma screening in patients with chronic hepatitis B in China: a cost–effectiveness analysis |
| title_full_unstemmed | Early-stage hepatocellular carcinoma screening in patients with chronic hepatitis B in China: a cost–effectiveness analysis |
| title_short | Early-stage hepatocellular carcinoma screening in patients with chronic hepatitis B in China: a cost–effectiveness analysis |
| title_sort | early stage hepatocellular carcinoma screening in patients with chronic hepatitis b in china a cost effectiveness analysis |
| topic | chronic hepatitis b cost–effectiveness analysis hepatocellular carcinoma screening |
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