Worthington Joachim, He Emily, Caruana Michael, Wade Stephen, de Graaff Barbara, Nguyen Anh Le Tuan, George Jacob, Canfell Karen, Feletto Eleonora
The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia.
School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
MDM Policy Pract. 2025 Jun 26;10(1):23814683251344962. doi: 10.1177/23814683251344962. eCollection 2025 Jan-Jun.
Liver cancer is the only cancer in Australia with rising incidence and mortality rates, despite the potential for early detection through surveillance of high-risk individuals. Hepatocellular carcinoma (HCC), the most common form of primary liver cancer, has curative treatment options available if detected early. Six-monthly HCC surveillance is recommended for people with liver cirrhosis and was proposed for inclusion in the 2023 Cancer Council Australia . To evaluate the proposed 2023 guideline recommendation, we developed Policy1-Liver, a novel mathematical model of liver disease, HCC, and surveillance. We then assessed the health and economic implications of 6-monthly HCC surveillance in Australia via ultrasound, with or without alpha-fetoprotein. Policy1-Liver was calibrated to existing data sources on liver disease, HCC, and health care costs in Australia. We assessed the impact of 6-monthly routine HCC surveillance with ultrasound with or without alpha-fetoprotein testing as well as a range of other sensitivity analyses and alternative scenarios such as varying surveillance adherence and intervals to assess potential future modifications to surveillance. We estimated that 6-monthly HCC surveillance, with or without alpha-fetoprotein, can increase early-stage diagnoses to up to 81% and reduce HCC mortality by 22% in people with cirrhosis. We estimate an incremental cost-effectiveness ratio of $28,423 per quality-adjusted life-year for 6-monthly surveillance with ultrasound alone compared with no surveillance. These findings support guideline-recommended 6-monthly HCC surveillance with ultrasound, affirming its health benefits and cost-effectiveness, and demonstrate the potential to improve cost-effectiveness by refining surveillance intervals and improving early-stage HCC survival. Supporting implementation of the surveillance guidelines will play a key role in improving HCC mortality rates in Australia.
Routine surveillance can improve the likelihood of early-stage detection of liver cancer, improving survival.Our modeling found that routine HCC surveillance with ultrasound would be cost-effective for people with liver cirrhosis in Australia.These findings can inform guidelines and investment in liver cancer control for high-risk patients.
肝癌是澳大利亚唯一发病率和死亡率都在上升的癌症，尽管通过对高危个体进行监测有早期发现的可能。肝细胞癌（HCC）是原发性肝癌最常见的形式，如果早期发现，有治愈性治疗方案。建议对肝硬化患者每六个月进行一次HCC监测，并提议将其纳入2023年澳大利亚癌症协会的指南。为了评估2023年拟议的指南建议，我们开发了Policy1-Liver，这是一种关于肝病、HCC和监测的新型数学模型。然后，我们评估了在澳大利亚通过超声进行每六个月一次的HCC监测（无论是否检测甲胎蛋白）对健康和经济的影响。Policy1-Liver根据澳大利亚关于肝病、HCC和医疗保健成本的现有数据源进行了校准。我们评估了每六个月进行一次常规HCC超声监测（无论是否检测甲胎蛋白）的影响，以及一系列其他敏感性分析和替代方案，如不同的监测依从性和间隔时间，以评估未来对监测可能的调整。我们估计，无论是否检测甲胎蛋白，每六个月进行一次HCC监测可使肝硬化患者的早期诊断率提高至81%，并将HCC死亡率降低22%。我们估计，与不进行监测相比，仅通过超声进行每六个月一次的监测，每质量调整生命年的增量成本效益比为28,423澳元。这些发现支持指南建议的每六个月通过超声进行一次HCC监测，确认了其健康益处和成本效益，并表明通过优化监测间隔和提高早期HCC生存率有提高成本效益的潜力。支持实施监测指南将在提高澳大利亚HCC死亡率方面发挥关键作用。
常规监测可提高肝癌早期发现的可能性，改善生存率。我们的模型发现，对澳大利亚肝硬化患者进行常规HCC超声监测具有成本效益。这些发现可为高危患者的肝癌控制指南制定和投资提供参考。
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