Expanding hepatocellular carcinoma surveillance strategies in high-risk patients in Switzerland: a cost-effectiveness...

European and Swiss guidelines recommend hepatocellular carcinoma surveillance of high-risk patients every 6 months using ultrasound (US), with/without α-fetoprotein (AFP). Other surveillance strategies are available, but evidence of their comparative cost-effectiveness is lacking. This study evaluated the cost-effectiveness of current hepatocellular carcinoma surveillance strategies in Switzerland, including the novel GAAD (gender [biological sex], age, α-fetoprotein, protein induced by vitamin K absence or antagonist-II [PIVKA-II]) serum-based algorithm in high-risk patients.

A micro-simulated Markov model estimated the cost-effectiveness of hepatocellular carcinoma surveillance strategies (no surveillance, US, US+AFP, GAAD) performed at 6-monthly intervals in a simulated cohort of 100,000 patients with compensated liver cirrhosis over a lifetime horizon. Performance parameters were sourced from published meta-analyses and multicentre study data. Epidemiological parameters were estimated based on literature identified during a previous systematic literature review. Similarly, utility parameters were sourced from published literature. Costs were sourced from TARMED, the Analysis List, the Swiss Federal Statistical Office, publicly available data and published literature. Primary outcomes were life years lived, quality-adjusted life years, and costs per patient and per cohort. The cost-effectiveness of each strategy was analysed through incremental cost-effectiveness ratios at a cost-effectiveness threshold of Swiss Franc (CHF) 100,000/quality-adjusted life year.

Overall, the total costs and quality-adjusted life years per patient, respectively, were CHF 43,493.61 and 5.893 for no surveillance; CHF 48,702.79 and 6.018 for US; CHF 49,980.60 and 6.042 for US+AFP; and CHF 49,983.10 and 6.048 for GAAD. Compared with US+AFP and US alone, GAAD was cost-effective, with higher quality-adjusted life years and the highest rate of early-stage hepatocellular carcinoma detection (56%). Compared with no surveillance, incremental cost-effectiveness ratios for US, US+AFP and GAAD were considered to be cost-effective, ranging from CHF 41,509.01 to CHF 43,321.81.

The current model indicates that hepatocellular carcinoma surveillance with any of these strategies was cost-effective in Switzerland. GAAD was nearly cost-neutral versus US+AFP, although these findings were dependent on the performance of GAAD and operator-dependent US combined with AFP. Compared with US alone, GAAD was the most cost-effective strategy. Further investigations are required to confirm these findings and to optimise hepatocellular carcinoma surveillance.