Cost‐Utility Analysis of Biomarker‐Based vs. USG  +  AFP Strategies for HCC Surveillance in Chronic Hepatitis B

作者：Tanat Saeoui, Chayanis Kositamongkol, Ratthanan Chantrakul, Pimsiri Sripongpun, Naichaya Chamroonkul, Chanon Kongkamol, Pochamana Phisalprapa, Apichat Kaewdech · 发表于：Alimentary Pharmacology & Therapeutics · 年份：2025 · DOI：10.1111/apt.70386 · 被引用次数：5 · 研究领域：Hepatocellular Carcinoma Treatment and Prognosis、Hepatitis B Virus Studies、Liver Disease Diagnosis and Treatment

BACKGROUND: The standard surveillance for hepatocellular carcinoma (HCC) involves ultrasound (USG) with alpha-fetoprotein (AFP) every 6 months. However, limitations, such as restricted access, radiologist shortages, and uncertain cost-effectiveness, persist. AIMS: We assessed the cost-effectiveness of traditional and biomarker-based HCC surveillance strategies in patients with chronic hepatitis B (CHB). METHODS: A Markov model simulated a cohort of patients with CHB to evaluate the cost-effectiveness of various surveillance strategies: USG + AFP, GAAD, GALAD, ASAP, and no surveillance. Input parameters were sourced from literature and Thai healthcare data. The analysis adopted a societal perspective and lifetime horizon, calculating incremental cost-effectiveness ratios (ICERs) in Thai Baht (THB) per quality-adjusted life year (QALY) gained. Sensitivity analyses assessed robustness. RESULTS: ASAP every 6 months was the most cost-effective strategy, with ICERs of 102,443 THB (~2957 USD) per QALY versus ASAP every 12 months and 76,447 THB (~2207 USD) per QALY versus no surveillance. Although GAAD and GALAD every 6 months achieved similar QALYs, they were dominated due to higher costs. Annual surveillance improved cost-effectiveness but remained inferior to ASAP every 6 months. USG + AFP every 6 months incurred the highest lifetime cost (166,253 THB, ~4800 USD). Sensitivity analyses confirmed the robustness of ASAP every 6 months, with key drivers including biomarker costs, HCC ...