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Cost-effectiveness of semi-annual surveillance for hepatocellular carcinoma in cirrhotic patients of the Italian Liver Cancer population
- Publication Year :
- 2012
-
Abstract
- BACKGROUND AND AIMS: It was recently shown that semi-annual surveillance for hepatocellular carcinoma (HCC) in cirrhotic patients provides a prognostic advantage over the annual program; however, its cost-effectiveness (CE) in the general cirrhotic population still needs to be defined. METHODS: A Markov model was built to compare CE of these two strategies, considering literature results and treatment modalities of 918 cirrhotic patients from the Italian Liver Cancer (ITA.LI.CA) database. RESULTS: Results from the Markov model suggest that, compared to annual surveillance, semi-annual surveillance leads to a gain in quality-adjusted life expectancy, in an unselected cirrhotic population, of 1.35 quality-adjusted life-months (QALMs) over 10 years since surveillance start in compensated patients, and of 0.73 QALMs in decompensated patients. Semi-annual surveillance was more cost-effective in compensated than in decompensated cirrhosis, with an incremental CE ratio (ICER) of 1997 and 3814€/QALM, respectively. In compensated cirrhosis, semi-annual surveillance was more cost-effective than the annual program when the annual HCC incidence was ≥3.2% and the relative survival gain after cancer diagnosis was ≥20% with respect to the annual program. In decompensated cirrhosis, semi-annual surveillance was cost-effective in patients amenable to liver transplantation. In both groups, CE of semi-annual surveillance improved with the increase of annual incidence and the survival benefit obtainable with HCC treatment. CONCLUSIONS: Both surveillance strategies for HCC in cirrhotic patients can be recommended, according to the individual risk profile for HCC occurrence and the expected survival gain obtainable after tumor diagnosis and therapy.
- Subjects :
- Adult
Liver Cirrhosis
Male
medicine.medical_specialty
Carcinoma, Hepatocellular
Cost effectiveness
Cost-Benefit Analysis
medicine.medical_treatment
Population
COST-EFFECTIVENESS ANALYSIS
Liver transplantation
Risk Factors
Internal medicine
SURVEILLANCE
medicine
Humans
HEPATOCELLULAR CARCINOMA
Intensive care medicine
education
Survival rate
CIRRHOSIS
Aged
Aged, 80 and over
education.field_of_study
Hepatology
Relative survival
business.industry
Incidence
Liver Neoplasms
Odds ratio
Middle Aged
Prognosis
medicine.disease
Markov Chains
Survival Rate
Italy
Population Surveillance
Female
business
Liver cancer
Incremental cost-effectiveness ratio
Subjects
Details
- Language :
- English
- Database :
- OpenAIRE
- Accession number :
- edsair.doi.dedup.....72f92490317410c76092e717e00b0d53