Cost-Effectiveness of Population-Based Hepatocellulararcinoma Screening -- Comparison between Ultrasonographycreening and Two-stage Screening

Hepatocellular carcinoma (HCC) is one of the most common cancers and is the leading cause of cancer death in Taiwan. Hepatocellular carcinoma in early stage is usually asymptomatic and patients commonly manifest with advanced diseases. Curative surgery is only feasible for a few patients and it’s extremely important to make early diagnosis of HCC. Ultrasonography (US) is widely believed to be an effective form of secondary prevention for HCC and many studies showed its efficacy to increase the detecting rate of small tumor and increase the proportion of curative treatment . However there is a lack of empirical evidence showing the cost-effectiveness of US screening . Markov model was used to estimate the expected lifetime costs and outcomes associated with screening strategies for HCC in a hypothetical cohort of 40-yr-old community residents. We compared the following strategies for HCC screening: No screening, two-stage screening and mass screening with US. Parameters of natural history , sensitivity and specificity of biochemical screenig were derived from our previous studies of two-stage liver cancer screening. Accuracy of ultrasonograpy screening , mortality associated with the specific stage of liver were based on meta-analysis. Deterministic and probabilistic sensitivity analysis were performed to assess the effects of uncertainty of parameters. We also evaluate the relative costs and effectiveness by comparing different screening strategies with different inter-screening interval and initial age.ass screening with ultrasonography was associated with an incremental cost-effectiveness ratio of NT $1,874,433 per life-year gained whereas two-stage screening was associated with an incremental cost-effectiveness ratio of NT $ 2,164,578 per life-year gained compared with no screening .Mass screening with ultrasongoraphy seems cost-effective than two-stage screening. The screening programs intiated at the age of 50 years and with biennial screning interval have a better cost-effevtiveness ratio. n conclusion mass screening with ultrasonography, particularly intiated form 50 years of age with two inter-screening interval, is more cost-effective than two-stage screening . The relative cost-effectiveness may vary with costs of screening tools and the specificity of biochemical screening.