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    Liver and Bile

    J Hepatol. 2022;77(1):55–62

    Mueller PP, Chen Q, Ayer T, Nemutlu GS, Hajjar A, Bethea ED, Peters MLB, Lee BP, Janjua NZ, Kanwal F, Chhatwal J

    Duration and cost-effectiveness of hepatocellular carcinoma surveillance in hepatitis C patients after viral eradication


    Background and aims: Successful treatment of chronic hepatitis C with oral direct-acting antivirals (DAAs) leads to virological cure, however, the subsequent risk of hepatocellular carcinoma (HCC) persists. Objective of the present study was to evaluate the cost-effectiveness of biannual surveillance for HCC in patients cured of hepatitis C and the optimal age to stop surveillance.
    Methods: The authors developed a microsimulation model of the natural history of HCC in individuals with hepatitis C and advanced fibrosis or cirrhosis who achieved virological cure with oral DAAs. They used published data on HCC incidence, tumor progression, real-world HCC surveillance adherence, and costs and utilities of different health states. Biannual HCC surveillance using ultrasound and alpha-fetoprotein for varying durations of surveillance (from 5 years to lifetime) versus no surveillance was compared.
    Results: In virologically cured patients with cirrhosis, the incremental cost-effectiveness ratio (ICER) of biannual surveillance remained below USD 150,000 per additional quality-adjusted life year (QALY) (range: USD 79,500 – USD 94,800) when surveillance was stopped at age 70, irrespective of the starting age (40–65). Compared with no surveillance, surveillance detected 130 additional HCCs in “very early”/early stage and yielded 51 additional QALYs per 1000 patients with cirrhosis. In virologically cured patients with advanced fibrosis, the ICER of biannual surveillance remained below USD 150,000/QALY (range: USD 124,600 – USD 129,800) when surveillance was stopped at age 60, irrespective of the starting age (40–50). Compared with no surveillance, surveillance detected 24 additional HCCs in “very early”/early stage and yielded 12 additional QALYs per 1000 patients with advanced fibrosis.

    Conclusion: Biannual surveillance for hepatocellular carcinoma in patients cured of hepatitis C is cost-effective until the age of 70 for patients with cirrhosis, and until the age of 60 for patients with stable advanced fibrosis.

    J. Chhatwal, Ph.D., Assistant Professor, MGH Institute for Technology Assessment, Harvard Medical School, Boston, MA, USA,
    E-Mail: jagchhatwal@mgh.harvard.edu

    DOI: 10.1016/j.jhep.2022.01.027

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