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Cost-Effectiveness of Hepatocellular Carcinoma Surveillance Strategies in Patients With Compensated Liver Cirrhosis in the United Kingdom

  • 0Global Access and Policy, Roche Diagnostics International, Rotkreuz, Switzerland.
Value in Health : the Journal of the International Society for Pharmacoeconomics and Outcomes Research +

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August 10, 2024

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August 10, 2024

View abstract on PubMed

Summary

This summary is machine-generated.

The GAAD algorithm, combining biomarkers and patient data, offers a cost-effective strategy for hepatocellular carcinoma surveillance in the UK. GAAD alone is preferred for cost-effectiveness, while GAAD plus ultrasound provides the highest clinical effectiveness.

Area Of Science

  • Hepatobiliary Medicine
  • Health Economics
  • Biomarker Assay Development

Background

  • Hepatocellular carcinoma (HCC) surveillance is crucial for early detection and improved patient outcomes.
  • Current surveillance strategies in the UK, such as ultrasound (US) and alpha-fetoprotein (AFP) testing, have varying cost-effectiveness.
  • Novel surveillance algorithms are needed to optimize resource allocation and clinical effectiveness.

Purpose Of The Study

  • To evaluate and compare the cost-effectiveness (CE) of four hepatocellular carcinoma (HCC) surveillance strategies in the United Kingdom.
  • To identify the most economically viable and clinically effective surveillance approach for HCC in the UK National Health Service (NHS).

Main Methods

  • A de novo microsimulation state-transition Markov model was developed in Microsoft Excel®.
  • The model simulated a cohort of 100,000 patients to calculate life-years, quality-adjusted life-years (QALYs), and costs.
  • Parameters were derived from peer-reviewed literature, national guidelines, and public cost databases, with sensitivity and scenario analyses performed.

Main Results

  • The GAAD algorithm (Gender, Age, Elecsys® biomarker assays, AFP, PIVK-II) alone was the most cost-effective strategy at a CE threshold of £20,000/QALY.
  • GAAD combined with ultrasound (US) was the most clinically effective strategy, yielding the highest QALYs, despite being the most costly.
  • Sensitivity analyses highlighted HCC incidence and diagnostic performance costs as key determinants of CE.

Conclusions

  • GAAD alone or GAAD + US are suggested as cost-effective HCC surveillance strategies in the UK, outperforming US and US + AFP.
  • While GAAD + US offers the highest QALY increase, GAAD alone is recommended for its superior cost-effectiveness.
  • Further research with improved performance estimates for GAAD + US is warranted to confirm its potential benefits.

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