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Cost evaluation of PAGE-B risk score guided HCC surveillance in patients with treated chronic hepatitis B
Martin F Sprinzl1,2, Christina Feist3, Sandra Koch3
1Medical Department I, University Medical Center of the Johanne Gutenberg University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany. martin.sprinzl@unimedizin-mainz.de.
Insights
The PAGE-B score helps identify chronic hepatitis B patients who can safely postpone hepatocellular carcinoma (HCC) screening, reducing healthcare costs. This tailored ultrasound approach offers significant savings for both patients and healthcare systems.
Area of Science:
- Hepatology
- Oncology
- Health Economics
Background:
- Chronic hepatitis B (cHB) patients require regular screening for hepatocellular carcinoma (HCC).
- The PAGE-B score (Platelet Age Gender-HBV) identifies cHB patients with a low risk of developing HCC within 5 years.
- Current screening protocols may lead to unnecessary costs for low-risk patients.
Purpose of the Study:
- To evaluate the cost-effectiveness of implementing a PAGE-B score-tailored ultrasound screening strategy for cHB patients.
- To determine potential cost reductions in HCC screening for cHB patients undergoing stable antiviral therapy.
Main Methods:
- A cohort of cHB patients attending a single center in 2018 was analyzed.
- Patients were stratified into high, intermediate, and low HCC risk groups using the PAGE-B score (≥18, 10-17, ≤9 points, respectively).
- Full costs of hepatic ultrasound examinations were assessed, including direct and indirect patient expenses.
Main Results:
- Out of 607 cHB patients, 227 were eligible for PAGE-B scoring, with 94 (15.8%) in the low-risk group.
- Sonographic HCC screening averaged 12.4 minutes per exam, costing €22.82, plus additional patient opportunistic costs (€15.6-€26.7).
- A PAGE-B tailored screening approach reduced annual costs by 15.51% for cHB patients and 1.91% for the sonography unit.
Conclusions:
- PAGE-B score-adapted screening is an efficient tool for reducing HCC screening costs in cHB patients on antiviral therapy.
- This strategy allows Caucasian cHB patients in the low-risk group to postpone sonographic screening, optimizing resource allocation.
- The implementation of PAGE-B tailored screening is cost-neutral and beneficial for managing healthcare expenses in cHB.
Background:
The PAGE-B score (Platelet Age GEnder-HBV) selects chronic hepatitis B (cHB) patients showing no relevant 5-year risk for hepatocellular carcinoma (HCC). We, therefore, explored potential cost reduction following the introduction of a PAGE-B tailored ultrasound screening in a single center cohort of cHB patients receiving stable antiviral therapy.
Methods:
cHB patients attending throughout the year 2018 were documented. Patients eligible for PAGE-B score were classified into high (≥18 points), intermediate (10-17 points) and low (≤9 points) HCC risk groups. Patients of the low HCC risk group could postpone HCC screening to reduce HCC screening expenses. Full costs for hepatic ultrasound were assessed.
Results:
Throughout the year cHB patients (n = 607) attended our clinic, which included PAGE-B eligible patients (n = 227, 37.4%) of whom n = 94 (15.8%) were allocated to the low HCC risk group. Sonographic HCC screening during a median exam time of 12.4 min (IQR 9.2-17.2) resulted in total costs of 22.82 Euro/exam. Additional opportunistic expenses caused by patient's lost earnings or productivity were 15.6-17.5 €/exam and 26.7 €/exam, respectively. Following a PAGE-B tailored HCC screening at our institution annual full costs for cHB patients could be reduced by 15.51%, which equals a cost reduction by 1.91% for our total sonography unit. In comparison, 1.35% up to 7.65% of HBV-infected patients of Caucasian descent could postpone HCC screening according to population-based estimates from Germany.
Conclusions:
PAGE-B risk score adapted screening for HCC is an efficient and cost neutral tool to reduce costs for sonography in Caucasian patients with chronic hepatitis B receiving antiviral treatment.
