Kuo M.-J.Chen, Tony Hsiu HsiTony Hsiu HsiChenCHI-LING CHENFann J.C.-Y.Chen S.L.-S.Chiu S.Y.-H.Lin Y.-M.Liao C.-S.Chang H.-C.Lin Y.-S.Yen A.M.-F.2022-01-252022-01-2520161007-9327https://www.scopus.com/inward/record.uri?eid=2-s2.0-84996520549&doi=10.3748%2fwjg.v22.i12.3460&partnerID=40&md5=490cb374a607c82587db20b9ea306842https://scholars.lib.ntu.edu.tw/handle/123456789/593392Aim: To assess the cost-effectiveness of two populationbased hepatocellular carcinoma (HCC) screening programs, two-stage biomarker-ultrasound method and mass screening using abdominal ultrasonography (AUS). Methods: In this study, we applied a Markov decision model with a societal perspective and a lifetime horizon for the general population-based cohorts in an area with high HCC incidence, such as Taiwan. The accuracy of biomarkers and ultrasonography was estimated from published meta-analyses. The costs of surveillance, diagnosis, and treatment were based on a combination of published literature, Medicare payments, and medical expenditure at the National Taiwan University Hospital. The main outcome measure was cost per lifeyear gained with a 3% annual discount rate. Results: The results show that the mass screening using AUS was associated with an incremental costeffectiveness ratio of USD39825 per life-year gained, whereas two-stage screening was associated with an incremental cost-effectiveness ratio of USD49733 per life-year gained, as compared with no screening. Screening programs with an initial screening age of 50 years old and biennial screening interval were the most cost-effective. These findings were sensitive to the costs of screening tools and the specificity of biomarker screening. Conclusion: Mass screening using AUS is more cost effective than two-stage biomarker-ultrasound screening. The most optimal strategy is an initial screening age at 50 years old with a 2-year inter-screening interval. ? 2016 Baishideng Publishing Group Inc. All rights reserved.Age; Cost-effectiveness; Markov model; One-stage abdominal ultrasonography screening; Sensitivity analysis; Two-stage biomarker-ultrasound screening[SDGs]SDG3age; Article; cancer staging; cost effectiveness analysis; disease surveillance; echography; hidden Markov model; human; liver cell carcinoma; mass screening; sensitivity analysis; Taiwan; adult; aged; blood; blood analysis; Carcinoma, Hepatocellular; comparative study; cost benefit analysis; decision support system; diagnostic imaging; early cancer diagnosis; echography; economic model; economics; female; health care cost; Liver Neoplasms; male; Markov chain; middle aged; predictive value; procedures; prognosis; reproducibility; biological marker; Adult; Aged; Biomarkers; Blood Chemical Analysis; Carcinoma, Hepatocellular; Cost-Benefit Analysis; Decision Support Techniques; Early Detection of Cancer; Female; Health Care Costs; Humans; Liver Neoplasms; Male; Markov Chains; Middle Aged; Models, Economic; Predictive Value of Tests; Prognosis; Reproducibility of Results; Taiwan; Ultrasonographyjournal article10.3748/wjg.v22.i12.3460270222282-s2.0-84996520549