Cost of Liver Cancer Screening in Patients with Cirrhosis

Speaker(s)

Samur S1, Rustgi VK2, Parikh ND3, Yang JD4, Roberts LR5, Nguyen MH6, Ozbay AB7, Ayer T8, Singal AG9, Chhatwal J10
1Value Analytics Labs, Chantilly, VA, USA, 2Rutgers University, New Brunswick, NJ, USA, 3University of Michigan, Ann Arbor, MI, USA, 4Karsh Division of Gastroenterology and Hepatology, Los Angeles, CA, USA, 5Mayo Clinic, Rochester, MN, USA, 6Stanford University Medical Center, Stanford, CA, USA, 7Exact Sciences, Madison, WI, USA, 8Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA, 9University of Texas, Dallas, TX, USA, 10Harvard University, Boston, MA, USA

Presentation Documents

OBJECTIVES: Hepatocellular carcinoma (HCC), the most common form of primary liver cancer, is the fastest growing cause of cancer deaths among Americans. Guidelines recommend biannual ultrasound-based screening, with or without a serum biomarker alpha fetoprotein (AFP) for early detection of HCC in at-risk individuals with cirrhosis. Our objective was to estimate the overall cost of HCC screening from a commercial healthcare system’s perspective.

METHODS: We developed a Markov-based microsimulation model that simulates the natural history of HCC in patients with compensated cirrhosis. We simulated biannual screening using ultrasound only, and ultrasound+AFP. We used published data to inform underlying liver disease progression rates, HCC tumor growth patterns, performance characteristics of screening modalities, and real-world screening adherence patterns. The cost of screening and diagnostic tests were estimated from the Truven MarketScan Database, and all other costs were estimated from published literature. The costs of ultrasound, ultrasound+AFP, magnetic resonance imaging, computed tomography, and liver biopsy were $378, $458, $2,027, $1,061 and $2,532, respectively.

RESULTS: The number of screening tests needed to detect one HCC case were 129 with ultrasound and 117 with ultrasound+AFP. For a 50-year-old individual, the average lifetime cost of HCC screening (until age 75) was $6,412 per person ($4,323 for screening and $2,089 for diagnostic tests) using ultrasound, and $ 8,586 per person ($5,220 for screening and $3,366 for diagnostic tests) using ultrasound+AFP. The cost to detect 1 HCC was $71,471 using ultrasound only and $87,636 using ultrasound+AFP.

CONCLUSIONS: We provide one of the first estimates of healthcare system costs for HCC screening in patients with cirrhosis. Our results could help commercial payers understand the cost burden associated with currently available HCC screening modalities.

Code

EE508

Topic

Economic Evaluation, Medical Technologies, Methodological & Statistical Research, Study Approaches

Topic Subcategory

Decision Modeling & Simulation, Diagnostics & Imaging

Disease

Medical Devices