Details:

Alternative Title:
Int J Circumpolar Health
Personal Author:
Gounder, Prabhu P ; Bulkow, Lisa R ; Meltzer, Martin I ; Bruce, Michael G ; Hennessy, Thomas W ; ... More +
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 Less -
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
Source:
Int J Circumpolar Health 2016; 75
Pubmed ID:
27197711
Pubmed Central ID:
PMC4873562
Document Type:
Journal Article
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:

Supporting Files

• 	IJCH-75-31115-g001.gif	gif
  	IJCH-75-31115-g001.jpg	jpeg
  	IJCH-75-31115.nxml	bin
  	license.txt	txt

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