The potential for primary and secondary prevention of liver cancer death in Australians with alcohol-related liver disease or metabolic-associated steatotic liver disease: A modelling study

Abstract

Objectives

Hepatocellular carcinoma (HCC), the most common form of primary liver cancer, is increasing in incidence and mortality in Australia, and the proportion attributable to excess alcohol intake, overweight and obesity is rising. People with alcohol-related liver disease (ARLD) or metabolic dysfunction-associated steatotic liver disease (MASLD) are at high risk, but prevention via weight loss, alcohol cessation, and routine surveillance can reduce the likelihood of HCC death. We aimed to estimate the potential for HCC prevention in Australians with ARLD and MASLD.

Study design

Simulation modelling study.

Methods

The existing Policy1-Liver model of liver disease was extended to capture disease progression in people with ARLD and MASLD. A weight loss intervention, alcohol cessation, and routine HCC surveillance using FIB-4, transient elastography, and ultrasound were simulated, and the impacts on HCC burden and costs were estimated.

Results

A once-off 10% weight loss intervention would reduce risk of MASLD-related HCC death by 25.9%. Up to 417 Australian HCC deaths would be preventable annually through this intervention. Alcohol cessation could double quality-adjusted life expectancy of people with ARLD.

Routine HCC surveillance would reduce ARLD-related HCC death risk by 18.6 % and MASLD-related HCC death risk by 18.1%, and prevent up to 254 MASLD- and ARLD-related HCC deaths in Australia annually. Surveillance would be cost-effective, except for those with early-stage MASLD.

Conclusions

Weight loss, alcohol cessation, and routine HCC surveillance can improve health outcomes for people with ARLD or MASLD. Modelling to support cost-effective prevention can help guide policy decisions and future investment in liver cancer control in Australia.