Hepatocellular carcinoma surveillance based on the Australian Consensus Guidelines: a health economic modelling study
Abstract Background Hepatocellular carcinoma (HCC) is the fastest increasing cause of cancer death in Australia. A recent Australian consensus guidelines recommended HCC surveillance for cirrhotic patients and non-cirrhotic chronic hepatitis B (CHB) patients at gender and age specific cut-offs. A co...
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| Format: | Article |
| Language: | English |
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BMC
2023-04-01
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| Series: | BMC Health Services Research |
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| Online Access: | https://doi.org/10.1186/s12913-023-09360-4 |
| _version_ | 1797841156970643456 |
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| author | Anh Le Tuan Nguyen Lei Si John S Lubel Nicholas Shackel Kwang Chien Yee Mark Wilson Jane Bradshaw Kerry Hardy Andrew John Palmer Christopher Leigh Blizzard Barbara de Graaff |
| author_facet | Anh Le Tuan Nguyen Lei Si John S Lubel Nicholas Shackel Kwang Chien Yee Mark Wilson Jane Bradshaw Kerry Hardy Andrew John Palmer Christopher Leigh Blizzard Barbara de Graaff |
| author_sort | Anh Le Tuan Nguyen |
| collection | DOAJ |
| description | Abstract Background Hepatocellular carcinoma (HCC) is the fastest increasing cause of cancer death in Australia. A recent Australian consensus guidelines recommended HCC surveillance for cirrhotic patients and non-cirrhotic chronic hepatitis B (CHB) patients at gender and age specific cut-offs. A cost-effectiveness model was then developed to assess surveillance strategies in Australia. Methods A microsimulation model was used to evaluate three strategies: biannual ultrasound, biannual ultrasound with alpha-fetoprotein (AFP) and no formal surveillance for patients having one of the conditions: non-cirrhotic CHB, compensated cirrhosis or decompensated cirrhosis. One-way and probabilistic sensitivity analyses as well as scenario and threshold analyses were conducted to account for uncertainties: including exclusive surveillance of CHB, compensated cirrhosis or decompensated cirrhosis populations; impact of obesity on ultrasound sensitivity; real-world adherence rate; and different cohort’s ranges of ages. Results Sixty HCC surveillance scenarios were considered for the baseline population. The ultrasound + AFP strategy was the most cost-effective with incremental cost-effectiveness ratios (ICER) compared to no surveillance falling below the willingness-to-pay threshold of A$50,000 per quality-adjusted life year (QALY) at all age ranges. Ultrasound alone was also cost-effective, but the strategy was dominated by ultrasound + AFP. Surveillance was cost-effective in the compensated and decompensated cirrhosis populations alone (ICERs < $30,000), but not cost-effective in the CHB population (ICERs > $100,000). Obesity could decrease the diagnostic performance of ultrasound, which in turn, reduce the cost-effectiveness of ultrasound ± AFP, but the strategies remained cost-effective. Conclusions HCC surveillance based on Australian recommendations using biannual ultrasound ± AFP was cost-effective. |
| first_indexed | 2024-04-09T16:26:31Z |
| format | Article |
| id | doaj.art-88c307713f7e441c97586d9ef824669d |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-04-09T16:26:31Z |
| publishDate | 2023-04-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj.art-88c307713f7e441c97586d9ef824669d2023-04-23T11:12:39ZengBMCBMC Health Services Research1472-69632023-04-0123111510.1186/s12913-023-09360-4Hepatocellular carcinoma surveillance based on the Australian Consensus Guidelines: a health economic modelling studyAnh Le Tuan Nguyen0Lei Si1John S Lubel2Nicholas Shackel3Kwang Chien Yee4Mark Wilson5Jane Bradshaw6Kerry Hardy7Andrew John Palmer8Christopher Leigh Blizzard9Barbara de Graaff10Menzies Institute for Medical Research, University of TasmaniaSchool of Health Sciences, Western Sydney UniversityAlfred HealthUniversity of New South WalesSchool of Medicine, University of TasmaniaSchool of Medicine, University of TasmaniaRoyal Hobart HospitalRoyal Hobart HospitalMenzies Institute for Medical Research, University of TasmaniaMenzies Institute for Medical Research, University of TasmaniaMenzies Institute for Medical Research, University of TasmaniaAbstract Background Hepatocellular carcinoma (HCC) is the fastest increasing cause of cancer death in Australia. A recent Australian consensus guidelines recommended HCC surveillance for cirrhotic patients and non-cirrhotic chronic hepatitis B (CHB) patients at gender and age specific cut-offs. A cost-effectiveness model was then developed to assess surveillance strategies in Australia. Methods A microsimulation model was used to evaluate three strategies: biannual ultrasound, biannual ultrasound with alpha-fetoprotein (AFP) and no formal surveillance for patients having one of the conditions: non-cirrhotic CHB, compensated cirrhosis or decompensated cirrhosis. One-way and probabilistic sensitivity analyses as well as scenario and threshold analyses were conducted to account for uncertainties: including exclusive surveillance of CHB, compensated cirrhosis or decompensated cirrhosis populations; impact of obesity on ultrasound sensitivity; real-world adherence rate; and different cohort’s ranges of ages. Results Sixty HCC surveillance scenarios were considered for the baseline population. The ultrasound + AFP strategy was the most cost-effective with incremental cost-effectiveness ratios (ICER) compared to no surveillance falling below the willingness-to-pay threshold of A$50,000 per quality-adjusted life year (QALY) at all age ranges. Ultrasound alone was also cost-effective, but the strategy was dominated by ultrasound + AFP. Surveillance was cost-effective in the compensated and decompensated cirrhosis populations alone (ICERs < $30,000), but not cost-effective in the CHB population (ICERs > $100,000). Obesity could decrease the diagnostic performance of ultrasound, which in turn, reduce the cost-effectiveness of ultrasound ± AFP, but the strategies remained cost-effective. Conclusions HCC surveillance based on Australian recommendations using biannual ultrasound ± AFP was cost-effective.https://doi.org/10.1186/s12913-023-09360-4Hepatocellular carcinomaSurveillanceCost-effectivenessUltrasoundAlpha-fetoprotein |
| spellingShingle | Anh Le Tuan Nguyen Lei Si John S Lubel Nicholas Shackel Kwang Chien Yee Mark Wilson Jane Bradshaw Kerry Hardy Andrew John Palmer Christopher Leigh Blizzard Barbara de Graaff Hepatocellular carcinoma surveillance based on the Australian Consensus Guidelines: a health economic modelling study BMC Health Services Research Hepatocellular carcinoma Surveillance Cost-effectiveness Ultrasound Alpha-fetoprotein |
| title | Hepatocellular carcinoma surveillance based on the Australian Consensus Guidelines: a health economic modelling study |
| title_full | Hepatocellular carcinoma surveillance based on the Australian Consensus Guidelines: a health economic modelling study |
| title_fullStr | Hepatocellular carcinoma surveillance based on the Australian Consensus Guidelines: a health economic modelling study |
| title_full_unstemmed | Hepatocellular carcinoma surveillance based on the Australian Consensus Guidelines: a health economic modelling study |
| title_short | Hepatocellular carcinoma surveillance based on the Australian Consensus Guidelines: a health economic modelling study |
| title_sort | hepatocellular carcinoma surveillance based on the australian consensus guidelines a health economic modelling study |
| topic | Hepatocellular carcinoma Surveillance Cost-effectiveness Ultrasound Alpha-fetoprotein |
| url | https://doi.org/10.1186/s12913-023-09360-4 |
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