Lowering HCC incidence threshold in guidelines cost-effective, may improve early detection
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Key takeaways:
- Hepatocellular carcinoma surveillance was cost-effective in virologically cured patients with hepatitis C at incidence of 0.7% vs. current 1.5%.
- Surveillance at 0.7% could result in 5,700 additional life-years.
Research demonstrated that hepatocellular carcinoma surveillance is cost-effective at a lower incidence threshold of 0.7% in virologically cured patients with hepatitis C virus, underscoring the need to update clinical guidelines.
“Hepatitis C treatment represents cure, but some patients remain at risk of developing HCC, the most common form of liver cancer,” Jagpreet Chhatwal, PhD, director of the Institute for Technology Assessment at Massachusetts General Hospital and associate professor at Harvard Medical School, told Healio. “Clinical guidelines recommend routine screening for HCC if the annual incidence of HCC exceeds 1.5%. This recommendation is based on old data; therefore, we investigated the contemporary incidence threshold above which routine HCC screening is cost-effective.”
Using a Markov-based microsimulation model of the natural history of HCC among virologically cured patients with HCV and cirrhosis or advanced fibrosis, Chhatwal and colleagues reported that HCC surveillance was cost-effective if incidence exceeds 0.7 per 100 person-years using $100,000 per quality-adjusted life-year willingness to pay.
“At this incidence rate, implementing regular surveillance with ultrasound and alpha-fetoprotein would lead to 2,650 to 5,700 additional life-years per 100,000 individuals, compared to no surveillance,” Chhatwal said.
Results, which were published in Clinical Gastroenterology and Hepatology, also showed that at $150,000 willingness to pay, surveillance was cost-effective if HCC incidence exceeds 0.4 per 100 person-years. This threshold “mostly remained below” 1.5 per 100 person-years in a sensitivity analysis.
“There is a need to update the clinical guidelines to recommend HCC screening when the incidence of HCC exceeds 0.7%, instead of the old recommendation of 1.5%,” Chhatwal added. “This update has the potential to improve early detection of HCC. Implementing this change in practice would increase the proportion of hepatitis C patients at risk who become eligible for HCC screening, creating opportunities for earlier intervention and care.”
He continued: “Future research is needed to identify subgroups of non-cirrhosis patients who have HCC incidence rate higher than 0.7%. These patients could benefit from routine HCC screening using the HCC risk threshold recommended by this study.”
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