Cost-Effectiveness of Hepatocellular Carcinoma Surveillance Strategies in Patients With Compensated Liver Cirrhosis in the United Kingdom

被引:3
作者
Garay, Osvaldo Ulises [1 ]
Ambuhl, Louisa Elena
Bird, Thomas G. [2 ]
Barnes, Eleanor [3 ]
Irving, William L. [4 ,5 ]
Walkley, Ryan
Rowe, Ian A.
机构
[1] Roche Diagnost Int, Global Access & Policy, Forrenstr 2, CH-6343 Rotkreuz ZG, Switzerland
[2] Univ Edinburgh, Queens Med Res Inst, Ctr Inflammat Res, Edinburgh, Scotland
[3] Univ Oxford, Nuffield Dept Med, Oxford, England
[4] Nottingham Univ Hosp NHS Trust, NIHR Nottingham Biomed Res Ctr, Nottingham, England
[5] Univ Nottingham, Nottingham, England
关键词
cost-effectiveness; GAAD; HCC; surveillance; biomarker; algorithm; EFFECTIVENESS THRESHOLD; NATURAL-HISTORY; HEPATITIS-C; CANCER; CHEMOEMBOLIZATION; POPULATION; MORTALITY; DISEASE; COHORT; RISK;
D O I
10.1016/j.jval.2024.07.015
中图分类号
F [经济];
学科分类号
02 ;
摘要
Objectives: This study aimed to evaluate the cost-effectiveness (CE) of 4 hepatocellular carcinoma (HCC) surveillance strategies in the United Kingdom, the GAAD algorithm, which combines Gender (biological sex) and Age with Elecsys (R) biomarker assays, alpha-fetoprotein (AFP) and protein induced by vitamin K absence-II (previously Des-g-carboxy prothrombin); ultrasound (US); US + AFP and GAAD + US. Methods: Ade novo microsimulation state-transition Markov model was developed in Microsoft Excel (R) from the perspective of the United Kingdom National Health Service to calculate life-years, quality- adjusted life-years (QALYs), costs, incremental CE ratios, and net monetary benefits. Parameters were sourced from peer-reviewed published literature, national guidelines, and public cost databases. Sensitivity and scenario analyses were performed to evaluate the impact of parameter and structural uncertainty on the results. Results: In a simulated cohort of 100 000 patients, discounted costs and QALYs per patient were 8663 pound and 6$066 for US, 9095 pound and 6$076 for US + AFP, 8719 pound and 6$078 for GAAD alone, and 9114 pound and 6$086 for GAAD + US. At a CE threshold of 20 pound 000/QALY, GAAD was the most costeffective strategy; however, although most costly, GAAD + US was the most clinically effective. Sensitivity and scenario analyses indicated that HCC incidence along with costs associated with diagnostic performance influence CE. Conclusion: Considering the cost of US and low incidence of HCC in the United Kingdom, this study suggests that GAAD alone or in combination with US are cost-effective surveillance strategies compared with US and US + AFP. Although GAAD + US showed the highest QALY increase, GAAD alone is considered preferable regarding CE; however, better performance estimates for GAAD + US are needed to confirm.
引用
收藏
页码:1698 / 1709
页数:12
相关论文
共 72 条
[1]   Hepatocellular carcinoma surveillance: current practice and future directions [J].
Ahn, Joseph C. ;
Lee, Yi-Te ;
Agopian, Vatche G. ;
Zhu, Yazhen ;
You, Sungyong ;
Tseng, Hsian-Rong ;
Yang, Ju Dong .
HEPATOMA RESEARCH, 2022, 8
[2]   Risks and clinical predictors of cirrhosis and hepatocellular carcinoma diagnoses in adults with diagnosed NAFLD: real-world study of 18 million patients in four European cohorts [J].
Alexander, Myriam ;
Loomis, A. Katrina ;
van der Lei, Johan ;
Duarte-Salles, Talita ;
Prieto-Alhambra, Daniel ;
Ansell, David ;
Pasqua, Alessandro ;
Lapi, Francesco ;
Rijnbeek, Peter ;
Mosseveld, Mees ;
Waterworth, Dawn M. ;
Kendrick, Stuart ;
Sattar, Naveed ;
Alazawi, William .
BMC MEDICINE, 2019, 17 (1)
[3]  
[Anonymous], Cirrhosis in over 16s: assessment and management.
[4]  
[Anonymous], 2012, METHODS DEV NICE PUB
[5]  
[Anonymous], How long is the wait for a liver?
[6]  
[Anonymous], National tariff payment system document,annexes and supporting documents.
[7]  
[Anonymous], National Cost Collection Data Publication: National Schedule 2022/23
[8]  
[Anonymous], Sorafenib for treating advanced hepatocellular carcinoma.
[9]   NICE's cost effectiveness threshold - How high should it be? [J].
Appleby, John ;
Devlin, Nancy ;
Parkin, David .
BRITISH MEDICAL JOURNAL, 2007, 335 (7616) :358-359
[10]  
Arguedas MR, 2003, AM J GASTROENTEROL, V98, P679, DOI [10.1016/S0002-9270(02)06049-5, 10.1111/j.1572-0241.2003.07327.x]