Cost-Effectiveness of Liver Cancer Screening in Adults at High Risk for Liver Cancer in the Republic of Korea
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PurposeThis study was conducted in order to determine the most cost-effective strategy, interms of interval and age range, for liver cancer screening in the high-risk populationof Korea. Materials and MethodsA stochastic model was used to simulate the cost-effectiveness of liver cancer screeningby combined ultrasonography and alpha-fetoprotein testing when varying bothscreening intervals and age ranges. The effectiveness of these screening strategiesin the high-risk population was defined as the probability of detecting preclinical livercancer, and cost was based on the direct cost of the screening and confirmative tests. Optimal cost-effectiveness was determined using the incremental cost-effectivenessratio. ResultsAmong the 36 alternative strategies, one-year or two-year interval screening for menaged between 50 and 80 years, six-month or one-year interval screening for menaged between 40 and 80 years, and six-month interval screening for men agedbetween 30 and 80 years were identified as non-dominated strategies. For women,identified non-dominated strategies were: one-year interval screening between age50 and 65 years, one-year or six-month interval screening between age 50 and 80years, six-month interval screening between age 40 and 80 years, and six-monthinterval screening between age 30 and 80 years. ConclusionIn Korea, a one-year screening interval for men aged 50 to 80 years would bemarginally cost-effective. Further studies should be conducted in order to evaluateeffectiveness of liver cancer screening, and compare the cost effectiveness of differentliver cancer screening programs with a final outcome indicator such as qualityadjustedlife-years or disability-adjusted life-years.
Abstract
PurposeThis study was conducted in order to determine the most cost-effective strategy, interms of interval and age range, for liver cancer screening in the high-risk populationof Korea. Materials and MethodsA stochastic model was used to simulate the cost-effectiveness of liver cancer screeningby combined ultrasonography and alpha-fetoprotein testing when varying bothscreening intervals and age ranges. The effectiveness of these screening strategiesin the high-risk population was defined as the probability of detecting preclinical livercancer, and cost was based on the direct cost of the screening and confirmative tests. Optimal cost-effectiveness was determined using the incremental cost-effectivenessratio. ResultsAmong the 36 alternative strategies, one-year or two-year interval screening for menaged between 50 and 80 years, six-month or one-year interval screening for menaged between 40 and 80 years, and six-month interval screening for men agedbetween 30 and 80 years were identified as non-dominated strategies. For women,identified non-dominated strategies were: one-year interval screening between age50 and 65 years, one-year or six-month interval screening between age 50 and 80years, six-month interval screening between age 40 and 80 years, and six-monthinterval screening between age 30 and 80 years. ConclusionIn Korea, a one-year screening interval for men aged 50 to 80 years would bemarginally cost-effective. Further studies should be conducted in order to evaluateeffectiveness of liver cancer screening, and compare the cost effectiveness of differentliver cancer screening programs with a final outcome indicator such as qualityadjustedlife-years or disability-adjusted life-years.
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