Int J Circumpolar Health

BackgroundThe American Association for the Study of Liver Diseases (AASLD) recommends semi-annual hepatocellular carcinoma (HCC) screening using ultrasound (US) in persons with chronic hepatitis B (CHB) virus infection at high risk for HCC such as Asian males aged \ue2\u2030\ua540 years and Asian females aged \ue2\u2030\ua550 years.ObjectiveTo analyse the cost-effectiveness of 2 HCC screening methods in the Alaska Native (AN) health system: US-alone, or screening by alpha-fetoprotein (AFP) initially and switching to US for subsequent screenings if AFP >10 ng/mL (AFP\ue2\u2020\u2019US).DesignA spreadsheet-based model was developed for accounting the costs of 2 hypothetical HCC screening methods. We used epidemiologic data from a cohort of 839 AN persons with CHB who were offered HCC screening by AFP/US semi-annually during 1983\ue2\u20ac\u201c2012. We assumed that compared with AFP\ue2\u2020\u2019US, US-alone identifies 33% more tumours at an early stage (defined as a single tumour \ue2\u2030\ua45 cm or \ue2\u2030\ua43 tumours \ue2\u2030\ua43 cm in diameter). Years of life gained (YLG) attributed to screening was estimated by comparing additional years of survival among persons with early- compared with late-stage tumours. Screening costs were calculated using Medicare reimbursement rates in 2012. Future screening costs and YLG were projected over a 30-year time horizon using a 3% discount rate.ResultsThe total cost of screening for the cohort by AFP\ue2\u2020\u2019US would have been approximately $357,000 ($36,000/early-stage tumour detected) compared to $814,000 ($59,000/early-stage tumour detected) by US-alone. The AFP\ue2\u2020\u2019US method would have yielded an additional 27.8 YLG ($13,000/YLG) compared with 38.9 YLG ($21,000/YLG) for US-alone. Screening by US-alone would incur an additional $114,000 per extra early-tumour detected compared with AFP\ue2\u2020\u2019US and $41,000 per extra YLG.ConclusionsAlthough US-alone HCC screening might have yielded more YLG than AFP\ue2\u2020\u2019US, the reduced costs of the AFP\ue2\u2020\u2019US method could expand access to HCC screening in resource constrained settings.27197711PMC487356