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Gold standard HCC screening in patients with cirrhosis more cost-effective than real-life monitoring

Gold standard monitoring for hepatocellular carcinoma in patients with cirrhosis, as recommended by guidelines, was more cost-effective and beneficial to patients compared with real-life monitoring, according to the results of a simulation study.

“Compared with ‘real life’ monitoring, following the guidelines for screening — which recommends biannual ultrasound — increased life expectancy by an average of 5 months and was cost-effective at $1,754 per additional life year gained with French costs and at $32,415 per additional life year gained with U.S. costs,” according to a press release.

“The large difference between French and U.S. costs was explained by the 4- to 10-fold difference in unit costs for surveillance — clinic visits, tests — and for first-line curative treatments,” Isabelle Durand-Zaleski, MD, PhD, of the Jean Verdier Hospital, University of Paris, said in the press release.

Durand-Zaleski and colleagues used data from the CIRVIR and CHANGH cohorts to develop a Markov model for simulating a population of patients with compensated cirrhosis, and compared incidence, survival and costs associated with cirrhosis and HCC between gold standard and real-life monitoring over a 10-year period. Cost analyses were performed using French and U.S. health care perspectives.

Over the 10-year period, 37% of patients in the gold standard group were diagnosed with liver cancer vs. 34% in the real-life group, and overall survival was 76% with gold standard monitoring and 67% for real-life monitoring.

Mean survival was 7.18 years with gold standard monitoring vs. 6.81 years with real-life monitoring, for an increase of 0.37 years.

The cost in France was $87,476 for gold standard monitoring vs. $86,829 for real-life monitoring, for a difference of $648. In the U.S., the cost was $93,795 for gold standard monitoring vs. $81,829 for real-life monitoring, for a difference of $11,965.

The global incremental cost-effectiveness ratio was $1,754 per life-year gained in France and $32,415 per life-year gained in the U.S., “assuming the predefined case mix of first-line treatments in the two groups, with a clear predominance of [radiofrequency ablation] in the gold-standard monitoring group (57% vs. 15%),” the investigators wrote.

“In patients with cirrhosis, HCC surveillance performed in line with recommendations is life-saving and cost-effective,” they concluded. “These results highlight the pivotal role of intervention strategies aimed at improving HCC surveillance rates and quality in case of cirrhosis, both at the health care providers and patients’ levels.” – by Adam Leitenberger