Hepatocellular carcinoma screening in patients waiting for liver transplantation: A decision analytic model

Sammy Saab, David Ly, Jose Nieto, Fasiha Kanwal, David Lu, Steven Raman, Rafael Amado, Barbara Nuesse, Francisco Durazo, Steven Han, Douglas G. Farmer, Rafik M. Ghobrial, Hasan Yersiz, Pauline Chen, Kathy Schwegel, Leonard I. Goldstein, Myron Tong, Ronald W. Busuttil

Research output: Contribution to journalArticle

62 Scopus citations

Abstract

De novo hepatocellular carcinoma (HCC) may have a large impact on patients waiting for liver transplantation. The presence of HCC can lead to a status upgrade or removal from the waitlist. Our aim is to compare costs and outcomes of different liver cancer surveillance strategies. A Markov-based decision analytic model is created to simulate costs and health outcomes for a hypothetical cohort awaiting liver transplantation undergoing HCC screening. Three strategies of HCC screening are compared with the referent strategy of using alphafetaprotein (AFP) level alone: (1) ultrasound (U/S), (2) AFP plus U/S, and (3) computed tomography (CT). Screening is performed for all strategies at 6-month intervals. Selected tumors are treated locally. Costs and clinical outcomes are discounted. Using baseline assumptions, incremental cost-effectiveness ratios (ICERs) for U/S, U/S plus AFP, and CT are $60,300/life-year saved (LY), $74,000/LY, and $101,100/LY, respectively. The most cost-effective strategy was dependent on the relative costs of each screening modality. U/S screening becomes the dominant strategy when the cost of an AFP test is decreased. Our results show that screening with CT is associated the greatest gain in life expectancy and greatest costs. U/S screening strategy is the preferred screening strategy based on the lowest ICER. Ultimately, costs of the screening modalities determine the most cost-effective strategy.

Original languageEnglish (US)
Pages (from-to)672-681
Number of pages10
JournalLiver Transplantation
Volume9
Issue number7
DOIs
StatePublished - Jul 1 2003

ASJC Scopus subject areas

  • Surgery
  • Hepatology
  • Transplantation

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