期刊
CLINICAL AND TRANSLATIONAL GASTROENTEROLOGY
卷 8, 期 -, 页码 -出版社
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1038/ctg.2017.26
关键词
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资金
- FLAGS Foundation
- Nuovo-Soldati Cancer Research Foundation
- Geneva University Hospital
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health [DK099558, DK078772]
- Irma T. Hirschl Trust
- ERC-AdG HEPCIR from European Union
- U.S. Department of Defense [W81XWH-16-1-0363]
- Cancer Prevention Research Institute of Texas (CPRIT) [RP150587]
OBJECTIVES: Hepatocellular carcinoma (HCC) surveillance with biannual ultrasound is currently recommended for all patients with cirrhosis. However, clinical implementation of this one-size-fits-all approach is challenging as evidenced by its low application rate. We aimed to evaluate the cost-effectiveness of risk-stratified HCC surveillance strategies in patients with cirrhosis. METHODS: A Markov decision-analytic modeling was performed to simulate a cohort of 50-year-old subjects with compensated cirrhosis. Risk-stratified HCC surveillance strategies was implemented, in which patients were stratified into high-, intermediate-, or low-risk groups by HCC risk biomarker-based scores and assigned to surveillance modalities tailored to HCC risk (2 non-risk-stratified and 14 risk-stratified strategies) and compared with non-stratified biannual ultrasound. RESULTS: Quality-adjusted life expectancy gains for biannual ultrasound in all patients and risk-stratified strategies compared with no surveillance were 1.3 and 0.9-2.1 years, respectively. Compared with the current standard of biannual ultrasound in all cirrhosis patients, risk-stratified strategies applying magnetic resonance imaging (MRI) and/or ultrasound only in high-and intermediate-risk patients, without screening in low-risk patients, were cost-effective. Abbreviated MRI (AMRI) for high-and intermediate-risk patients had the lowest incremental cost-effectiveness ratio (ICER) of $2,100 per quality-adjusted life year gained. AMRI in intermediate-and high-risk patients had ICERs <$3,000 across a wide range of HCC incidences. CONCLUSIONS: Risk-stratified HCC surveillance strategies targeting high-and intermediate-risk patients with cirrhosis are cost-effective and outperform the currently recommended non-stratified biannual ultrasound in all patients with cirrhosis.
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