Cost-Utility Analysis of Biomarker-Based vs. USG + AFP Strategies for HCC Surveillance in Chronic Hepatitis B

The standard surveillance for hepatocellular carcinoma (HCC) involves ultrasound (USG) with alpha-fetoprotein (AFP) every 6 months. However, limitations, such as restricted access, radiologist shortages, and uncertain cost-effectiveness, persist.

We assessed the cost-effectiveness of traditional and biomarker-based HCC surveillance strategies in patients with chronic hepatitis B (CHB).

A Markov model simulated a cohort of patients with CHB to evaluate the cost-effectiveness of various surveillance strategies: USG + AFP, GAAD, GALAD, ASAP, and no surveillance. Input parameters were sourced from literature and Thai healthcare data. The analysis adopted a societal perspective and lifetime horizon, calculating incremental cost-effectiveness ratios (ICERs) in Thai Baht (THB) per quality-adjusted life year (QALY) gained. Sensitivity analyses assessed robustness.

ASAP every 6 months was the most cost-effective strategy, with ICERs of 102,443 THB (~2957 USD) per QALY versus ASAP every 12 months and 76,447 THB (~2207 USD) per QALY versus no surveillance. Although GAAD and GALAD every 6 months achieved similar QALYs, they were dominated due to higher costs. Annual surveillance improved cost-effectiveness but remained inferior to ASAP every 6 months. USG + AFP every 6 months incurred the highest lifetime cost (166,253 THB, ~4800 USD). Sensitivity analyses confirmed the robustness of ASAP every 6 months, with key drivers including biomarker costs, HCC stage utilities, and incidence rates.

ASAP every 6 months is the most cost-effective HCC surveillance strategy for patients with CHB and may be particularly suitable for resource-limited settings. Biomarker-based surveillance should be prioritised to improve outcomes and optimise resource use.