Duration & Cost-Effectiveness of Hepatocellular Carcinoma Surveillance in Hepatitis C Patients After Viral Eradication
2022
This study assesses the cost-effectiveness of biannual surveillance for hepatocellular carcinoma (HCC) in patients cured of hepatitis C virus (HCV) using oral direct-acting antivirals (DAAs). A microsimulation model of HCC natural history in individuals with HCV-related advanced fibrosis or cirrhosis post-DAAs was developed, integrating data on HCC incidence, tumor progression, surveillance adherence, and health state costs/utilities. Biannual ultrasound and alpha-fetoprotein surveillance were compared to no surveillance over varying durations (5 years to lifetime). Results indicate biannual surveillance is cost-effective until age 70 for cirrhotic patients and until age 60 for those with stable advanced fibrosis, with incremental cost-effectiveness ratios (ICERs) below $150,000 per quality-adjusted life year (QALY) gained. Surveillance detects additional HCC cases in early stages, offering significant QALY gains. The study highlights the value of continued surveillance in HCV-cured individuals to mitigate HCC risk, providing insights into optimal surveillance durations based on patient characteristics.
Source:
Mueller PP, Chen Q, Ayer T, Nemutlu GS, Hajjar A, Bethea ED, Peters MLB, Lee BP, Janjua NZ, Kanwal F, Chhatwal J. Duration and Cost-Effectiveness of Hepatocellular Carcinoma Surveillance in Hepatitis C Patients After Viral Eradication. Journal of Hepatology 2022; 77 (1): 55-62. https://doi.org/10.1016/j.jhep.2022.01.027
Not open access.