Cost-effectiveness Analysis of Hepatocellular Carcinoma Surveillance in Patients with Hepatitis C Related Cirrhosis after Sustained Virological Response

Hepatitis-C virus related cirrhosis is associated with hepatocellular carcinoma (HCC). Antiviral therapy resulting in a sustained virological response (SVR) substantially decreases the risk for HCC. Surveillance for HCC in cirrhosis patients has been shown to be cost-effective; whether it remains so post-SVR is unknown. A Markov model was developed to evaluate the cost-effectiveness of biannual ultrasound surveillance versus no surveillance for HCC in post-SVR patients from the healthcare-payer perspective. Parameter values were obtained from the literature and expert opinion. Primary outcomes were quality-adjusted life-years (QALYs) and costs, both discounted at 5%, and the incremental cost-effectiveness ratio (ICER). Surveillance, with 0.5% annual HCC incidence, provided an additional 0.0705 QALYs leading to an ICER of $204,301/QALY. Sensitivity analyses identified HCC incidence and transition to symptomatic disease in the unscreened population as the main drivers of the analysis. With current estimates of HCC incidence post-SVR, ultrasound surveillance is unlikely to be cost-effective.M.Sc