Cost-effectiveness of HCC Surveillance Strategies in Patients With Compensated Liver Cirrhosis in the United Kingdom

Garay, Osvaldo Ulises; Ambühl, Louisa Elena; Bird, Thomas G; Barnes, Eleanor; Irving, William L; Walkley, Ryan; Rowe, Ian A

Abstract

This study aimed to evaluate the cost-effectiveness (CE) of four hepatocellular carcinoma (HCC) surveillance strategies in the UK, the GAAD algorithm, which combines gender (biological sex) and age with Elecsys® biomarker assays, alpha-fetoprotein (AFP) and protein induced by vitamin K absence-II (PIVKA-II), ultrasound (US), US+AFP and GAAD+US. A de novo micro-simulation state-transition Markov model was developed in Microsoft Excel® from the perspective of the UK National Health Service to calculate life years, quality-adjusted life-years (QALYs), costs, incremental CE ratios, and net monetary benefits. Parameters were sourced from peer-reviewed published literature, national guidelines, and public cost databases. Sensitivity and scenario analyses were performed to evaluate the impact of parameter and structural uncertainty on the results. In a simulated cohort of 100,000 patients, discounted costs and QALYs per patient were £8,663 and 6·066 for US, £9,095 and 6·076 for US+AFP, £8,719 and 6·078 for GAAD alone, and £9,114 and 6·086 for GAAD+US. At a CE threshold of £20,000/QALY, GAAD was the most cost-effective strategy; however, although most costly, GAAD+US was the most clinically effective. Sensitivity and scenario analyses indicated that HCC incidence along with costs associated with diagnostic performance influence CE. Considering the cost of US and low incidence of HCC in the UK, this study suggests that GAAD alone or in combination with US are cost-effective surveillance strategies compared with US and US+AFP. Whilst GAAD+US showed the highest QALY increase, GAAD alone is considered preferable regarding CE; however, better performance estimates for GAAD+US are needed to confirm. [Abstract copyright: Copyright © 2024. Published by Elsevier Inc.]

Citation

Garay, O. U., Ambühl, L. E., Bird, T. G., Barnes, E., Irving, W. L., Walkley, R., & Rowe, I. A. (2024). Cost-effectiveness of HCC Surveillance Strategies in Patients With Compensated Liver Cirrhosis in the United Kingdom. Value in Health, https://doi.org/10.1016/j.jval.2024.07.015

• Journal Article Type: Article
• Acceptance Date: Jul 27, 2024
• Online Publication Date: Aug 8, 2024
• Publication Date: Aug 8, 2024
• Deposit Date: Sep 12, 2024
• Publicly Available Date: Sep 12, 2024
• Journal: Value in Health
• Print ISSN: 1098-3015
• Electronic ISSN: 1524-4733
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• DOI: https://doi.org/10.1016/j.jval.2024.07.015
• Keywords: GAAD, biomarker algorithm, surveillance, cost-effectiveness, HCC
• Public URL: https://nottingham-repository.worktribe.com/output/38897748
• Publisher URL: https://www.sciencedirect.com/science/article/pii/S1098301524027980