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Cost-effective liver cancer screening after HCV requires better risk cutoffs
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PARIS — Researchers evaluated the cost-effectiveness of regular hepatocellular carcinoma screening among patients with hepatitis C after sustained virologic response. In this exclusive video from the International Liver Congress 2018, Hooman Farhang Zangneh, MD, MSc, discusses the thresholds and limitations for cost-effective liver cancer screening.
“Hepatitis C virus ... is one of the major causes of hepatocellular carcinoma worldwide, although the risk for HCC formation decreases substantially after elimination of the virus,” Zangneh, from the Toronto Centre for Liver Disease at the University of Toronto, told Healio Gastroenterology and Liver Disease. “Surveillance for hepatocellular carcinoma has been shown to be cost-effective in patients with hepatitis C, pretreatment, if that risk is above 1.5% per year; however, after achieving SVR, these values will change dramatically.”
Current guidelines recommend biannual screening for patients with cirrhosis and advanced fibrosis prior to SVR.
For biannual U.S. screening to be cost-effective in the post-SVR population, according to Zangneh’s presentation, the constant annual HCC incidence must be above 1.1%. The researchers also found that biannual screening was unlikely to be cost-effective among patients with fibrosis stage 3 or pretreatment aspartate aminotransferase to platelet ratio index less than 2, challenging current practice guidelines.
The researchers also found that that biannual and annual screening is most likely cost-effective in patients with cirrhosis post-SVR if their HCC risk is considered to increase with age.
“Long-term follow-up studies and data will be required to identify those who are at risk for tumor development and also to better tailor surveillance guidelines,” Zangneh concluded. – by Talitha Bennett
For more information:
Zangneh HF, et al. PS-061. Presented at: International Liver Congress; Apr. 11-15, 2018; Paris, France.
Disclosure: Zangneh reports no relevant financial disclosures.