Cost-effectiveness analysis of hepatocellular carcinoma screening by combinations of ultrasound and alpha-fetoprotein among Alaska Native people, 1983–2012

Details

• Alternative Title:
  Int J Circumpolar Health
• Personal Author:
  Gounder, Prabhu P ; Bulkow, Lisa R ; Meltzer, Martin I ; Bruce, Michael G ; Hennessy, Thomas W ; Snowball, Mary ; Spradling, Philip R ; Adhikari, Bishwa B ; McMahon, Brian J
• Description:
  Background
  
  The American Association for the Study of Liver Diseases (AASLD) recommends semi-annual hepatocellular carcinoma (HCC) screening using ultrasound (U.S.) in persons with chronic hepatitis B (CHB) virus infection at high risk for HCC such as Asian males aged ≥40 years and Asian females aged ≥50 years
  
  Objective
  
  To analyze 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→US)
  
  Design
  
  A 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 1983–2012 We assumed that compared with AFP→US, US-alone identifies 33% more tumors at an early stage (defined as a single tumor ≤5 cm or ≤3 tumors ≤3 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 tumors 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
  
  Results
  
  The total cost of screening for the cohort by AFP→US would have been approximately $357,000 ($36,000/early-stage tumor detected) compared to $814,000 ($59,000/early-stage tumor detected) by US-alone The AFP→US method would have yielded an additional 278 YLG ($13,000/YLG) compared with 389 YLG ($21,000/YLG) for US-alone Screening by US-alone would incur an additional $114,000 per extra early-tumor detected compared with AFP→US and $41,000 per extra YLG
  
  Conclusions
  
  Although US-alone HCC screening might have yielded more YLG than AFP→US, the reduced costs of the AFP→US method could expand access to HCC screening in resource constrained settings
  
  
• Subjects:
  Adult Alaskan Natives Alpha-Fetoproteins Carcinoma, Hepatocellular Cost-Benefit Analysis Female Humans Liver Neoplasms Male Mass Screening Middle Aged Ultrasonography

  More +
• Source:
  Int J Circumpolar Health 2016; 75
• Pubmed ID:
  27197711
• Pubmed Central ID:
  PMC4873562
• Document Type:
  Journal Article
• Volume:
  75
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:01940ff6927cb89d877e7040a79725aa151f181421b0c3e3bbec3b6b079d643f
• Download URL:
  https://stacks.cdc.gov/view/cdc/39948/cdc_39948_DS1.pdf
• File Type:
  [PDF - 356.71 KB ]