OBJECTIVES : Early detection and screening of HCC in highly susceptible patients is of high importance and guidelines recommend screening in patients with increased risk for HCC. However, cost-effectiveness of optimal screening technique and interval has been a continued topic of debate

METHODS : Embase®, MEDLINE®, and Cochrane were searched from database start to January 2018. Studies assessing the cost-effectiveness potential of HCC screening using various techniques and considering different scenarios including no HCC screening and early HCC screening were included in the review

RESULTS : A total of 16 studies evaluating cost-effectiveness of HCC screening were included. Out of these 16 studies, four studies estimated cost-effectiveness for HCC screening in USA, three for Italy, two for UK, and one each for Japan and Korea. Remaining four studies did not mention any countries. Thirteen of the included studies were based on Markov modelling. At willingness to pay of $50,000 USD/QALY gained, semi-annual U/S surveillance was most cost-effective at incremental cost-effectiveness ratio (ICER) of $30,700 USD/QALY gained. Whereas, ICER for annual U/S was at $21,200 USD/QALY. ICERs for AFP/US ($73,500 USD/QALY) and CT scan ($331,800 USD/QALY) at 6 monthly intervals were very high for the WTP of $50,000 USD/QALY gained. Semi-annual AFP triage surveillance was the most cost-effective HCC screening strategy in mixed cohort of ALD (alcoholic liver disease), HBV and HCV associated cirrhosis patients in the UK. A sensitivity analysis showed that the cost of surveillance exceeds $50,000/QALY (threshold) if the annual incidence of HCC is 2.0%, less than 14% patients progressed from initial to advance stage or patient age exceeds 80 years

CONCLUSIONS : Semi-annual U/S surveillance for HCC cirrhotic patients improves clinical outcomes at reasonable cost