Abstract
Abstract:
Background & Aims:
Nonalcoholic fatty liver disease (NAFLD) is one of the leading causes of hepatocellular carcinoma (HCC). Yet, the cost effectiveness of HCC surveillance in individuals with NAFLD remains unclear. Our objective was to conduct a cost-effectiveness analysis to inform whether and for which NAFLD individuals HCC surveillance is cost-effective.
Methods:
We developed a simulation model of the natural history of HCC in individuals with NAFLD related advanced fibrosis or cirrhosis while accounting for competing risks of cardiovascular and non-HCC cancer mortality. We used published data on HCC incidence, tumor progression, real-world HCC surveillance adherence, contemporary HCC treatment options, associated costs, and utilities of different health states. We evaluated the cost-effectiveness of biannual HCC surveillance using ultrasound and alpha-fetoprotein versus no surveillance using willingness-to-pay thresholds of $100,000 per quality-adjusted life year (QALY).
Results:
Compared with no surveillance, biannual surveillance of 1,000 individuals with NAFLD related cirrhosis detected 45 additional HCCs in early stage, yielded 85 additional QALYs., resulting in the incremental cost-effectiveness ratio (ICER) of $26,776 per additional QALY. Compared with no surveillance, biannual surveillance of 1,000 individuals with NAFLD related advanced fibrosis detected 43 additional HCCs in early stage and yielded 63 additional QALYs. The ICER of surveillance was $42,580 per additional QALY in this cohort. Sensitivity analyses showed that the results were not sensitive to uncertainty in model inputs.
Conclusion:
Biannual HCC surveillance is cost-effective in individuals with NAFLD related cirrhosis and advanced fibrosis. Our study provides important data on the value of routine HCC surveillance and could inform updates needed in the clinical guidelines especially for individuals with NAFLD-related advanced fibrosis.