Abstract
Successful treatment of chronic hepatitis C with oral direct-acting antiviral (DAA) leads to virological cure, however, the subsequent risk of hepatocellular carcinoma (HCC) persists. Our objective was to evaluate the cost-effectiveness of biannual surveillance for HCC in patients cured of hepatitis C and the optimal age to stop surveillance.
We developed a microsimulation model of the natural history of HCC in hepatitis C individuals with advanced fibrosis or cirrhosis who achieved virological cure with oral DAAs. We used published data on HCC incidence, tumor progression, real-world HCC surveillance adherence, and costs and utilities of different health states. We compared biannual HCC surveillance using ultrasound and alpha-fetoprotein for varying durations of surveillance (from 5 years to lifetime) versus no surveillance.
In virologically-cured patients with cirrhosis, the ICER of biannual surveillance remained below $150,000 per additional quality-adjusted life year (QALY) (range: $79,500-$94,800) when surveillance was stopped at age 70, irrespective of the start age (40-65). Compared with no surveillance, surveillance per 1000 cirrhosis patients detected 130 additional HCCs in ‘very early’/early stage and yielded 51 additional QALYs. In virologically-cured patients with advanced fibrosis, the ICER of biannual surveillance remained below $150,000/QALY (range: $124,600-$129,800) when surveillance was stopped at age 60, irrespective of the start age (40-50). Compared with no surveillance, surveillance per 1000 advanced fibrosis patients detected 24 additional HCCs in ‘very early’/early stage and yielded 12 additional QALYs.
Biannual surveillance for HCC in virologically-cured hepatitis C patients is cost-effective until the age of 70 for cirrhosis patients, and until the age of 60 for patients with stable advanced fibrosis.
Individuals who are cured of hepatitis C using oral antiviral drugs remain at risk of developing liver cancer. The value of lifelong screening for liver cancer in these individuals is not known. By simulating the life course of hepatitis C cured individuals, we found that ultrasound-based bi-annual screening for liver cancer is cost-effective up to age 70 in those having cirrhosis and up to age 60 in those having stable advanced fibrosis.
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1.Individuals who are cured of hepatitis C using oral antiviral drugs remain at risk of developing hepatocellular carcinoma (HCC), however, the value of lifelong surveillance for HCC in these individuals is not known.2.By simulating the life course of hepatitis C cured individuals, we found that ultrasound-based bi-annual surveillance for HCC is cost-effective up to age 75 in those having cirrhosis and up to age 60 in those having stable advanced fibrosis.3.Compared with no surveillance, surveillance per 1000 cirrhosis patients detected 86 additional HCCs in ‘very early’/early stage and additional 65 HCCs in intermediate/advanced, and yielded additional 77 quality-adjusted life years. Surveillance per 1000 advanced fibrosis patients detected 14 additional HCCs in ‘very early’/early stage and 10 additional HCCs in intermediate/advanced, and yielded 23 additional quality-adjusted life years.
