Hepatocellular carcinoma surveillance based on the Australian Consensus Guidelines: a health economic modelling study

Nguyen, Anh Le Tuan; Si, Lei; Lubel, John S; Shackel, Nicholas; Yee, Kwang Chien; Wilson, Mark; Bradshaw, Jane; Hardy, Kerry; Palmer, Andrew John; Blizzard, Christopher Leigh; de Graaff, Barbara

doi:10.1186/s12913-023-09360-4

Table 2 Cost-effectiveness analysis results of HCC surveillance: central adiposity

From: Hepatocellular carcinoma surveillance based on the Australian Consensus Guidelines: a health economic modelling study

Cohort starting age	Surveillance strategy	% Of early-stage HCC diagnosed	Cost	Incr. cost vs. next most cost-effective alternative	QALY	Incr. QALY vs. next most cost-effective alternative	ICER vs. next most cost-effective alternative	ICER vs. status quo	Dominance
20–80	Status quo	8.7	56,884		5.55
	Ultrasound_real-world adherence	19.5	57,879	995	5.58	0.02	40,222	40,222	Extendedly dominated^†
	Ultrasound + AFP_real-world adherence	22.9	58,408	1,524	5.60	0.04	34,249	34,249
	Ultrasound_full adherence	41.5	59,234	826	5.59	-0.01	-99,541	64,894	Absolutely dominated^§
	Ultrasound + AFP_full adherence	53.2	60,279	1,871	5.63	0.03	59,522	44,710
30–80	Status quo	8.4	55,992		5.42
	Ultrasound_real-world adherence	19.8	57,037	1,045	5.45	0.03	41,003	41,003	Extendedly dominated
	Ultrasound + AFP_real-world adherence	23.2	57,598	1,606	5.47	0.05	35,271	35,271
	Ultrasound_full adherence	41.8	58,467	869	5.46	-0.00	-201,771	60,033	Absolutely dominated
	Ultrasound + AFP_full adherence	52.8	59,549	1,951	5.50	0.03	56,166	44,311
40–80	Status quo	8.6	54,986		5.25
	Ultrasound_real-world adherence	20.3	55,972	986	5.27	0.02	42,545	42,545	Extendedly dominated
	Ultrasound + AFP_real-world adherence	23.7	56,445	1,459	5.29	0.04	36,258	36,258
	Ultrasound_full adherence	42.1	57,236	791	5.28	-0.01	-87,612	72,074	Absolutely dominated
	Ultrasound + AFP_full adherence	53.1	58,159	1,714	5.32	0.02	71,394	49,387
50–80	Status quo	8.1	53,215		5.04
	Ultrasound_real-world adherence	20.3	54,162	947	5.06	0.02	54,071	54,071	Extendedly dominated
	Ultrasound + AFP_real-world adherence	23.7	54,663	1,448	5.08	0.03	41,830	41,830
	Ultrasound_full adherence	42.1	55,318	655	5.07	-0.01	-97,534	75,385	Absolutely dominated
	Ultrasound + AFP_full adherence	52.8	56,227	1,564	5.10	0.03	61,866	50,287
20–70	Status quo	8.3	58,090		5.66
	Ultrasound_real-world adherence	19.1	59,093	1,003	5.69	0.03	39,210	39,210	Extendedly dominated
	Ultrasound + AFP_real-world adherence	22.3	59,665	1,574	5.71	0.05	34,007	34,007
	Ultrasound_full adherence	41.7	60,492	828	5.70	-0.01	-105,045	62,528	Absolutely dominated
	Ultrasound + AFP_full adherence	52.9	61,614	1,949	5.75	0.03	56,870	43,733
30–70	Status quo	8.7	57,531		5.59
	Ultrasound_real-world adherence	19.7	58,518	987	5.61	0.02	41,068	41,068	Extendedly dominated
	Ultrasound + AFP_real-world adherence	23.0	59,060	1,529	5.63	0.04	34,816	34,816
	Ultrasound_full adherence	41.6	59,940	879	5.62	-0.01	-107,583	67,387	Absolutely dominated
	Ultrasound + AFP_full adherence	52.8	61,014	1,954	5.66	0.03	60,301	45,636
40–70	Status quo	8.7	56,774		5.45
	Ultrasound_real-world adherence	19.8	57,738	964	5.47	0.02	48,459	48,459	Extendedly dominated
	Ultrasound + AFP_real-world adherence	23.2	58,266	1,492	5.49	0.04	37,674	37,674
	Ultrasound_full adherence	41.6	59,048	782	5.48	-0.01	-123,501	68,343	Absolutely dominated
	Ultrasound + AFP_full adherence	52.9	60,078	1,812	5.52	0.03	54,921	45,513
50–70	Status quo	8.3	55,562		5.28
	Ultrasound_real-world adherence	19.9	56,481	919	5.30	0.02	47,382	47,382	Extendedly dominated
	Ultrasound + AFP_real-world adherence	23.3	57,026	1,464	5.32	0.04	37,316	37,316
	Ultrasound_full adherence	41.8	57,730	704	5.31	-0.01	-72,520	73,459	Absolutely dominated
	Ultrasound + AFP_full adherence	53.2	58,734	1,708	5.35	0.03	61,182	47,239
20–60	Status quo	8.5	59,044		5.80
	Ultrasound_real-world adherence	19.2	60,056	1,012	5.82	0.02	42,757	42,757	Extendedly dominated
	Ultrasound + AFP_real-world adherence	22.4	60,607	1,564	5.84	0.04	35,136	35,136
	Ultrasound_full adherence	41.8	61,439	832	5.83	-0.01	-101,613	65,954	Absolutely dominated
	Ultrasound + AFP_full adherence	53.0	62,575	1,968	5.88	0.03	56,373	44,470
30–60	Status quo	8.4	58,560		5.72
	Ultrasound_real-world adherence	19.3	59,558	998	5.74	0.02	42,470	42,470	Extendedly dominated
	Ultrasound + AFP_real-world adherence	22.5	60,104	1,544	5.76	0.04	35,356	35,356
	Ultrasound_full adherence	41.8	60,930	826	5.76	-0.00	-171,248	61,009	Absolutely dominated
	Ultrasound + AFP_full adherence	53.0	62,037	1,933	5.80	0.04	51,496	42,816
40–60	Status quo	8.4	58,002		5.61
	Ultrasound_real-world adherence	19.4	58,973	971	5.64	0.02	44,327	44,327	Extendedly dominated
	Ultrasound + AFP_real-world adherence	22.7	59,518	1,516	5.66	0.04	36,228	36,228
	Ultrasound_full adherence	41.8	60,371	853	5.65	-0.00	-175,380	64,048	Absolutely dominated
	Ultrasound + AFP_full adherence	53.1	61,450	1,932	5.69	0.03	55,314	44,910
50–60	Status quo	8.5	56,951		5.47
	Ultrasound_real-world adherence	19.8	57,938	987	5.49	0.02	42,155	42,155	Extendedly dominated
	Ultrasound + AFP_real-world adherence	23.2	58,480	1,529	5.51	0.04	35,170	35,170
	Ultrasound_full adherence	41.6	59,307	827	5.50	-0.01	-100,712	66,787	Absolutely dominated
	Ultrasound + AFP_full adherence	53.1	60,343	1,863	5.54	0.03	61,130	45,865

AFP; Alpha-Fetoprotein; HCC, hepatocellular carcinoma; ICER, Incremental cost-effectiveness ratio; Incr., incremental; QALY, quality adjusted life years
† A strategy with a higher ICER (relative to the next alternative) and lower QALY than the alternative was extendedly dominated by the alternative
§ A strategy with higher cost and lower QALY than the alternative was absolutely dominated by the alternative

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