Cost-effectiveness analysis of population-based screening of hepatocellular carcinoma: Comparing ultrasonography with two-stage screening

Ming Jeng Kuo, Hsiu Hsi Chen, Chi Ling Chen, Jean Ching Yuan Fann, Sam Li Sheng Chen, Sherry Yueh Hsia Chiu, Yu Min Lin, Chao Sheng Liao, Hung Chuen Chang, Yueh Shih Lin, Amy Ming Fang Yen

Research output: Contribution to journalArticlepeer-review

17 Citations (Scopus)


Aim: To assess the cost-effectiveness of two populationbased hepatocellular carcinoma (HCC) screening programs, two-stage biomarker-ultrasound method and mass screening using abdominal ultrasonography (AUS). Methods: In this study, we applied a Markov decision model with a societal perspective and a lifetime horizon for the general population-based cohorts in an area with high HCC incidence, such as Taiwan. The accuracy of biomarkers and ultrasonography was estimated from published meta-analyses. The costs of surveillance, diagnosis, and treatment were based on a combination of published literature, Medicare payments, and medical expenditure at the National Taiwan University Hospital. The main outcome measure was cost per lifeyear gained with a 3% annual discount rate. Results: The results show that the mass screening using AUS was associated with an incremental costeffectiveness ratio of USD39825 per life-year gained, whereas two-stage screening was associated with an incremental cost-effectiveness ratio of USD49733 per life-year gained, as compared with no screening. Screening programs with an initial screening age of 50 years old and biennial screening interval were the most cost-effective. These findings were sensitive to the costs of screening tools and the specificity of biomarker screening. Conclusion: Mass screening using AUS is more cost effective than two-stage biomarker-ultrasound screening. The most optimal strategy is an initial screening age at 50 years old with a 2-year inter-screening interval.

Original languageEnglish
Pages (from-to)3460-3470
Number of pages11
JournalWorld Journal of Gastroenterology
Issue number12
Publication statusPublished - Mar 28 2016


  • Age
  • Cost-effectiveness
  • Markov model
  • One-stage abdominal ultrasonography screening
  • Sensitivity analysis
  • Two-stage biomarker-ultrasound screening

ASJC Scopus subject areas

  • Gastroenterology


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