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Delivery of biannual ultrasound surveillance for individuals with cirrhosis and cured hepatitis C in the UK

Hamill, Victoria; Gelson, Will; MacDonald, Douglas; Richardson, Paul; Ryder, Stephen D.; Aldersley, Mark; McPherson, Stuart; Verma, Sumita; Sharma, Rohini; Hutchinson, Sharon; Benselin, Jennifer; Barnes, Eleanor; Guha, Indra Neil; Irving, William L.; Innes, Hamish

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Authors

Victoria Hamill

Will Gelson

Douglas MacDonald

Paul Richardson

Stephen D. Ryder

Mark Aldersley

Stuart McPherson

Sumita Verma

Rohini Sharma

Sharon Hutchinson

Jennifer Benselin

Eleanor Barnes

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NEIL GUHA neil.guha@nottingham.ac.uk
Professor of Hepatology

Hamish Innes



Abstract

Background: Previous studies show the uptake of biannual ultrasound (US) surveillance in patients with cirrhosis is suboptimal. Here, our goal was to understand in broader terms how surveillance is being delivered to cirrhosis patients with cured hepatitis C in the UK. Methods: Hepatitis C cirrhosis patients achieving a sustained viral response (SVR) to antiviral therapies were identified from the national Hepatitis-C-Research-UK resource. Data on (i) liver/abdominal US examinations, (ii) HCC diagnoses, and (iii) HCC curative treatment were obtained through record-linkage to national health registries. The rate of US uptake was calculated by dividing the number of US episodes by follow-up time. Results: A total of 1908 cirrhosis patients from 31 liver centres were followed for 3.8 (IQR: 3.4–4.9) years. Overall, 10 396 liver/abdominal USs were identified. The proportion with biannual US was 19% in the first 3 years after SVR and 9% for all follow-up years. Higher uptake of biannual US was associated with attending a liver transplant centre; older age and cirrhosis decompensation. Funnel plot analysis indicated significant inter-centre variability in biannual US uptake, with 6/29 centres outside control limits. Incident HCC occurred in 133 patients, of which 49/133 (37%) were treated with curative intent. The number of US episodes in the two years prior to HCC diagnosis was significantly associated with higher odds of curative-intent treatment (aOR: 1.53; 95% CI: 1.12–2,09; p=.007). Conclusions: This study provides novel data on the cascade of care for HCC in the UK. Our findings suggest biannual US is poorly targeted, inefficient and is not being delivered equitably to all patients.

Citation

Hamill, V., Gelson, W., MacDonald, D., Richardson, P., Ryder, S. D., Aldersley, M., …Innes, H. (2023). Delivery of biannual ultrasound surveillance for individuals with cirrhosis and cured hepatitis C in the UK. Liver International, 43(4), 917-927. https://doi.org/10.1111/liv.15528

Journal Article Type Article
Acceptance Date Jan 20, 2023
Online Publication Date Jan 28, 2023
Publication Date Jan 28, 2023
Deposit Date Jan 31, 2023
Publicly Available Date Jan 29, 2024
Journal Liver International
Print ISSN 1478-3223
Electronic ISSN 1478-3231
Publisher Wiley
Peer Reviewed Peer Reviewed
Volume 43
Issue 4
Pages 917-927
DOI https://doi.org/10.1111/liv.15528
Keywords Adherence; imaging; liver cancer; screening; ultrasonography
Public URL https://nottingham-repository.worktribe.com/output/16792856
Publisher URL https://onlinelibrary.wiley.com/doi/abs/10.1111/liv.15528

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