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

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.