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Cost-effectiveness analysis of population-based screening of hepatocellular carcinoma: Comparing ultrasonography with two-stage screening

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World Journal of Gastroenterology 2016年第12期22卷 3460-3470页

作者： Ming-Jeng Kuo Hsiu-Hsi Chen Chi-Ling Chen Jean Ching-Yuan Fann Sam Li-Sheng Chen Sherry Yueh-Hsia Chiu Yu-Min Lin Chao-Sheng Liao Hung-Chuen Chang Yueh-Shih Lin Amy Ming-Fang Yen Department of Hepatogastroenterology Tainan Municipal Hospital Tainan 701 Taiwan Graduate Institute of Epidemiology and Preventive Medicine College of Public Health National Taiwan University Taipei 100 Taiwan Graduate Institute of Clinical Medicine College of Medicine and Graduate Institute of Epidemiology and Preventive Medicine College of Public Health National Taiwan University Taipei 100 Taiwan Department of Health Industry Management School of Healthcare Management Kainan University Taoyuan 338 Taiwan School of Oral Hygiene College of Oral Medicine Taipei Medical University Taipei 110 Taiwan Department and Graduate Institute of Health Care Management Chang Gung University Taoyuan 333 Taiwan Division of Gastroenterology Department of Internal Medicine Shin-Kong Wu Ho-Su Memorial Hospital Taipei 111 Taiwan angder Health Clinics Taipei 111 Taiwan

AIM: 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 ***: 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.

关键词： Two-stage biomarker-ultrasound screening one-stage abdominal ultrasonography screening Markov model Cost-effectiveness Sensitivity analysis Age

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