OBJECTIVES: Many economic evaluations of HCC screening have been conducted, however these vary substantially with regards to type of intervention, patient group and setting. This review aims to extend the current knowledge of the cost-effectiveness of screening strategies and comprehensively synthesize the published data.

METHODS: We conducted a search on multiple biomedical and health economic databases and included full or partial health economic studies if they evaluated the costs and/or outcomes of HCC screening strategies. The outcomes were restricted to health economic measures.

RESULTS: The review included 36 studies. Due to significant heterogeneity in key aspects across the studies, a narrative synthesis was conducted. All studies reported using ultrasound (US) with or without alpha fetoprotein (AFP) as screening strategies. Screening intervals were mostly annual or biannual. We categorised and synthesized the data based on three key patient groups: cirrhotic, chronic hepatitis B (HBV), and high-risk populations with a range of liver diseases. Most of the studies reported screening resulted in improvements in patients’ health outcomes. Incidence, diagnostic performance and health state utility values were the most critical parameters affecting the cost-effectiveness of screening. Overall, the majority of studies reported HCC screening to be cost-effective, with the combination of US and AFP at 6-monthly intervals standing out as the most cost-effective strategy. However, only one study considered the utilisation rate, and no studies considered the diagnostic performance of US in the context of central adiposity. Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) were also evaluated, however were not cost-effective in comparison with US or no screening. However, due to the substantial limitations in most studies, results should be interpreted with caution.

CONCLUSIONS: Future health economics modelling studies should take into account the impact of central adiposity on the precision of US, real-world utilisation rate and projections of increased HCC incidence.