PURPOSE: Surveillance of patients of cirrhosis of liver is practiced for early detection of HCC. No data from any developing country on cost-effectiveness of such a program are available. METHODS: Economic evaluation of HCC surveillance was embedded in a prospective study undertaken to estimate the incidence of HCC in 194 cirrhotics. The protocol consisted of 6 monthly abdominal ultrasound (US) and serum alphafetoprotein (AFP) estimation, and yearly triple phase CT. Cost was estimated from the hospital and patient perspectives. Cost-effectiveness ratios for detecting a case of HCC were estimated. Modeling was done to estimate cost effectiveness with different combinations of diagnostic tests. RESULTS: Cost-effectiveness ratios of HCC surveillance program per HCC case detected were estimated as US$ 280 from the hospital perspective. From patient perspective, these were US$ 9,965 for outstation and US$ 2,808 for local patients. Cost-effectiveness ratio for direct medical cost per case of HCC detected by 6 monthly US and AFP, the EASL protocol, was estimated to be US$ 1,510 in the private sector. CONCLUSION: The cost of HCC surveillance program is exorbitant for India (gross national income per capita US$ 620) and possibly other low/middle income countries.
PURPOSE: Surveillance of patients of cirrhosis of liver is practiced for early detection of HCC. No data from any developing country on cost-effectiveness of such a program are available. METHODS: Economic evaluation of HCC surveillance was embedded in a prospective study undertaken to estimate the incidence of HCC in 194 cirrhotics. The protocol consisted of 6 monthly abdominal ultrasound (US) and serum alphafetoprotein (AFP) estimation, and yearly triple phase CT. Cost was estimated from the hospital and patient perspectives. Cost-effectiveness ratios for detecting a case of HCC were estimated. Modeling was done to estimate cost effectiveness with different combinations of diagnostic tests. RESULTS: Cost-effectiveness ratios of HCC surveillance program per HCC case detected were estimated as US$ 280 from the hospital perspective. From patient perspective, these were US$ 9,965 for outstation and US$ 2,808 for local patients. Cost-effectiveness ratio for direct medical cost per case of HCC detected by 6 monthly US and AFP, the EASL protocol, was estimated to be US$ 1,510 in the private sector. CONCLUSION: The cost of HCC surveillance program is exorbitant for India (gross national income per capita US$ 620) and possibly other low/middle income countries.
Authors: J Bruix; M Sherman; J M Llovet; M Beaugrand; R Lencioni; A K Burroughs; E Christensen; L Pagliaro; M Colombo; J Rodés Journal: J Hepatol Date: 2001-09 Impact factor: 25.083
Authors: L Bolondi; S Sofia; S Siringo; S Gaiani; A Casali; G Zironi; F Piscaglia; L Gramantieri; M Zanetti; M Sherman Journal: Gut Date: 2001-02 Impact factor: 23.059
Authors: Sammy Saab; David Ly; Jose Nieto; Fasiha Kanwal; David Lu; Steven Raman; Rafael Amado; Barbara Nuesse; Francisco Durazo; Steven Han; Douglas G Farmer; Rafik M Ghobrial; Hasan Yersiz; Pauline Chen; Kathy Schwegel; Leonard I Goldstein; Myron Tong; Ronald W Busuttil Journal: Liver Transpl Date: 2003-07 Impact factor: 5.799
Authors: S Mima; C Sekiya; H Kanagawa; H Kohyama; K Gotoh; H Mizuo; M Ijiri; T Tanabe; N Maeda; K Okuda Journal: J Gastroenterol Hepatol Date: 1994 Jul-Aug Impact factor: 4.029