Global Access and Policy, Roche Diagnostics International, Rotkreuz, Switzerland.
Global Access and Policy, Roche Diagnostics International, Rotkreuz, Switzerland.
Value Health. 2024 Dec;27(12):1698-1709. doi: 10.1016/j.jval.2024.07.015. Epub 2024 Aug 8.
This study aimed to evaluate the cost-effectiveness (CE) of 4 hepatocellular carcinoma (HCC) surveillance strategies in the United Kingdom, the GAAD algorithm, which combines Gender (biological sex) and Age with Elecsys® biomarker assays, alpha-fetoprotein (AFP) and protein induced by vitamin K absence-II (previously Des-γ-carboxy prothrombin); ultrasound (US); US + AFP and GAAD + US.
A de novo microsimulation state-transition Markov model was developed in Microsoft Excel® from the perspective of the United Kingdom National Health Service to calculate life-years, quality-adjusted life-years (QALYs), costs, incremental CE ratios, and net monetary benefits. Parameters were sourced from peer-reviewed published literature, national guidelines, and public cost databases. Sensitivity and scenario analyses were performed to evaluate the impact of parameter and structural uncertainty on the results.
In a simulated cohort of 100 000 patients, discounted costs and QALYs per patient were £8663 and 6·066 for US, £9095 and 6·076 for US + AFP, £8719 and 6·078 for GAAD alone, and £9114 and 6·086 for GAAD + US. At a CE threshold of £20 000/QALY, GAAD was the most cost-effective strategy; however, although most costly, GAAD + US was the most clinically effective. Sensitivity and scenario analyses indicated that HCC incidence along with costs associated with diagnostic performance influence CE.
Considering the cost of US and low incidence of HCC in the United Kingdom, this study suggests that GAAD alone or in combination with US are cost-effective surveillance strategies compared with US and US + AFP. Although GAAD + US showed the highest QALY increase, GAAD alone is considered preferable regarding CE; however, better performance estimates for GAAD + US are needed to confirm.
本研究旨在评估英国 4 种肝细胞癌（HCC）监测策略的成本效益（CE），即 GAAD 算法，该算法结合了性别（生物性别）和年龄与 Elecsys®生物标志物检测、甲胎蛋白（AFP）和维生素 K 缺乏-II 诱导蛋白（先前称为去γ-羧基凝血酶原）；超声（US）；US+AFP 和 GAAD+US。
从英国国家医疗服务体系的角度，在 Microsoft Excel®中开发了一种新的微观模拟状态转移马尔可夫模型，以计算生命年、质量调整生命年（QALYs）、成本、增量 CE 比和净货币收益。参数来源于同行评议的已发表文献、国家指南和公共成本数据库。进行了敏感性和情景分析，以评估参数和结构不确定性对结果的影响。
在模拟的 100000 名患者队列中，每位患者的折扣成本和 QALY 分别为 US 组的 8663 英镑和 6.066，US+AFP 组的 9095 英镑和 6.076，GAAD 组的 8719 英镑和 6.078，GAAD+US 组的 9114 英镑和 6.086。在 CE 阈值为 20000 英镑/QALY 的情况下，GAAD 是最具成本效益的策略；然而，尽管 GAAD+US 最昂贵，但它是最具临床效果的。敏感性和情景分析表明，HCC 的发病率以及与诊断性能相关的成本影响 CE。
考虑到英国 US 的成本和 HCC 的低发病率，本研究表明，与 US 和 US+AFP 相比，GAAD 单独或与 US 联合使用是具有成本效益的监测策略。尽管 GAAD+US 显示了最高的 QALY 增加，但就 CE 而言，GAAD 单独使用更为可取；然而，需要更好的 GAAD+US 性能估计来证实这一点。
