Presentation (CTI)

OBJECTIVES: Hepatitis B infection (HBV) is the most significant risk factor for hepatocellular carcinoma (HCC) in Thailand. The standard HCC surveillance is using ultrasound (US) with the biomarker AFP every six to twelve months. HCC detection rate can be improved by using the serum marker PIVKA-II in combination with AFP. This study estimated the cost-effectiveness of HCC surveillance strategies, including PIVKA-II, in HBV cirrhotic patients in Thailand.
METHODS: A state-transition model was developed to compare HCC screening strategies in patients with chronic HBV infection and compensated cirrhosis: US (1), US+AFP (2), US+AFP+PIVKA (3). The model followed a Thai health system perspective considering a willingness-to pay (WTP) threshold of I$60,000. Model inputs were based on a comprehensive literature review. Costs were derived from a Thai study, adjusted for inflation and converted into PPP 2021 Dollar. The model evaluated the number of diagnosed cases, the time with undiagnosed HCC, and the surveillance costs over a period of 20 years. The model was tested with univariate and probabilistic sensitivity analyses.
RESULTS: A total of 24% of patients developed HCC, of which 52%, 60%, and 72% of cases were detected in an early HCC stage by (1), (2), and (3). Considering a 6-months strategy, (3) allowed HCC cases to be detected on average 7.6 and 16.9 months earlier compared to (2) and (1). Compared to standard of care, (3) increased total costs by I$2,814, reduced costs to HCC diagnosis by I$44, gained 0.047 QALYs, and approached the WTP (I$/QALY 60,407). Utility weights, costs for palliative care, adherence rate and test specificity were the most critical factors influencing results in univariate sensitivity analyses. Probabilistic sensitivity analysis confirmed results and a 80% probability of (3) to be cost-effective.
CONCLUSIONS: A combined US+AFP+PIVKA surveillance strategy could detect HCC in high-risk populations earlier at reasonable lifetime costs and lower costs to diagnosis.