Cost-Effectiveness of Risk-Score-Based Surveillance Strategies for Hepatocellular Carcinoma in Patients with Chronic Hepatitis B.

Abstract

Background: In China, a significant number of individuals with chronic hepatitis B (CHB) are at risk of developing hepatocellular carcinoma (HCC). Due to low surveillance rates and guidelines that inadequately address resource constraints, this study evaluates the cost-effectiveness of risk-based HCC surveillance strategies in CHB patients in China.

Methods: We developed a state-transition model to simulate disease progression in hypothetical CHB cohorts over their lifetimes, considering various HCC risk scores to classify patients into low, intermediate, and high-risk categories. The model assessed the cost-effectiveness of five active surveillance strategies, including biannual monitoring, compared to no surveillance. Key outcomes included life expectancy, quality-adjusted life years (QALYs), total costs, and the incremental cost-effectiveness ratio (ICER), with comparisons to China's willingness-to-pay (WTP) threshold of $37,674 per QALY.

Results: For overall and intermediate-risk cohorts, biannual and annual surveillance were cost-effective (ICER < $37,674/QALY). In high-risk groups, all surveillance strategies, except quinquennial, were cost-effective, with ICERs ranging from $28,448 to $36,073 per QALY. No surveillance strategy was cost-effective for the low-risk group. Sensitivity analyses confirmed biannual surveillance had the highest probability of being cost-effective across all risk groups and was most sensitive to changes in mortality rates associated with intermediate to advanced HCC stages.

Conclusions: The cost-effectiveness of HCC surveillance in CHB patients varies based on HCC risk. A risk-stratified approach, with biannual surveillance prioritized for high-risk patients and potentially omitted for low-risk patients, could optimize resource allocation.