Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.
School of Medicine, University of Tasmania, Hobart, Tasmania, Australia.
Value Health. 2021 May;24(5):733-743. doi: 10.1016/j.jval.2020.11.014. Epub 2021 Mar 5.
Many economic evaluations of hepatocellular carcinoma (HCC) screenings 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.
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 or outcomes of HCC screening strategies.
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 or alpha fetoprotein as screening strategies. Screening intervals were mostly annual or biannual. Incidence, diagnostic performance, and health state utility values 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 + alpha fetoprotein standing out as the most cost-effective strategy. However, few studies considered the utilization rate, and none considered the diagnostic performance of ultrasound in the context of central adiposity. Computed tomography and magnetic resonance imaging were also evaluated, but its cost-effectiveness was still controversial.
Although 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 modeling studies should consider the impact of central adiposity on the precision of ultrasound, real-world utilization rates and projections of increased HCC incidence.
许多肝癌 (HCC) 筛查的经济评估已经进行；然而，这些评估在筛查策略、患者群体和环境方面存在很大差异。本综述旨在报告当前关于筛查的成本效益的知识，并描述已发表的数据。
我们对生物医学和健康经济数据库进行了搜索，截至 2020 年 7 月。如果评估了 HCC 筛查策略的成本或结果，我们将纳入完整和部分健康经济研究。
综述包括 43 项研究。由于研究之间在关键方面存在显著异质性，因此进行了叙述性综合。大多数研究报告使用超声或甲胎蛋白作为筛查策略。筛查间隔大多为每年或每两年一次。发病率、诊断性能和健康状态效用值是影响筛查成本效益的最关键参数。大多数研究报告 HCC 筛查具有成本效益，其中两年一次的超声+甲胎蛋白筛查策略最具成本效益。然而，很少有研究考虑利用率，也没有研究考虑到肥胖症对超声诊断性能的影响。计算机断层扫描和磁共振成像也进行了评估，但它们的成本效益仍存在争议。
尽管许多研究表明 HCC 筛查具有成本效益，但这些研究质量的重大局限性意味着结果应谨慎解释。未来的建模研究应考虑肥胖症对超声精度的影响、实际利用率以及 HCC 发病率增加的预测。
