Objectives: Many economic evaluations of hepatocellular carcinoma (HCC) screening have been conducted, however these vary substantially with regards to screening strategies, patient group and setting. This review aims to report the current knowledge of the cost-effectiveness of screening and describe the published data.

Methods: We conducted a search of biomedical and health economic databases up to July, 2020. We included full and partial health economic studies if they evaluated the costs and/or outcomes of HCC screening strategies.

Results: The review included 43 studies. Due to significant heterogeneity in key aspects across the studies, a narrative synthesis was conducted. Most studies reported using ultrasound and/or alpha fetoprotein (AFP) as screening strategies. Screening intervals were mostly annual or biannual. Incidence, diagnostic performance and health state utility values (HSUVs) were the most critical parameters affecting the cost-effectiveness of screening. The majority of studies reported HCC screening to be cost-effective, with the biannual ultrasound+AFP standing out as the most cost-effective strategy. However, few studies considered the utilisation rate, and none considered the diagnostic performance of ultrasound in the context of central adiposity. Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) were also evaluated, but its cost-effectiveness was still controversial.

Conclusion: Whilst many studies suggested HCC screening was cost-effective, substantial limitations of the quality of these studies means the results should be interpreted with caution. Future modelling studies should take into account the impact of central adiposity on the precision of ultrasound, real-world utilisation rates and projections of increased HCC incidence.

Item Type:	Refereed Article
Keywords:	cost-effectiveness, hepatocellular carcinoma, primary liver cancer, screening, surveillance
Research Division:	Economics
Research Group:	Applied economics
Research Field:	Health economics
Objective Division:	Health
Objective Group:	Public health (excl. specific population health)
Objective Field:	Public health (excl. specific population health) not elsewhere classified
UTAS Author:	Nguyen, ALT (Mr Anh Nguyen)
UTAS Author:	Nguyen, HTT (Miss Hoa Nguyen)
UTAS Author:	Yee, KC (Dr Kwang Yee)
UTAS Author:	Palmer, AJ (Professor Andrew Palmer)
UTAS Author:	Blizzard, CL (Professor Leigh Blizzard)
UTAS Author:	de Graaff, B (Dr Barbara de Graaff)
ID Code:	141829
Year Published:	2020
Web of Science® Times Cited:	4
Deposited By:	Menzies Institute for Medical Research
Deposited On:	2020-11-25
Last Modified:	2021-05-18
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