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The Cost-effectiveness of Alpha-fetoprotein and Liver Ultrasound for Semi-annual Hepatocellular Carcinoma
Screening in Human with Hepatitis B Surface Antigen Positive or Patients with Chronic Hepatitis B(P-7)

Attasit Srisubat1, Arkom Chaiwerawattana2, Sirirat Tunsakul2, Saowakon Sukarayodhin2, Chanin Apiwanich2,
Wutthi Sumetchotimaytha2, Aree Prasitthipayong2, Kanokporn Jaisathaporn2, Anant Karalak2, Arunee Thaiyakul1,
Nattiya Kapol3, Namfon Sribundit3, Nathorn Chaiyakunapruk4

1 Institute of Medical Research and Technology Assessment, Department of Medical Services, MoPH, Thailand.
2 National Cancer Institute, Department of Medical Services, MoPH, Thailand.
3 Faculty of Phamacy, Silpakorn University, Thailand.
4 Faculty of Pharmaceutical Sciences, Naresuan University, Thailand.

Background: Hepatocellular carcinoma (HCC) is the fifth cause of dead from cancer worldwide. There were
500,000 deaths whereas the incidence rate of HCC was 564,000 a year. Hepatitis B virus infection is the important
risk of HCC. Alpha fetoprotein (AFP) and liver ultrasound had been introduced as semi-annual screening test for HCC
in human with hepatitis B surface antigen positive or patients with chronic hepatitis B. However, the cost-effectiveness
of this screening is not well defined. Our objective was to evaluate the cost-utility analysis of semi-annual
HCC screening using AFP and liver ultrasound from societal prospective compared with no screening.

Methods: With a Markov model, we simulated the four health states of natural history of HCC which were no
HCC state, resectable HCC state, unresectable HCC state and death state. The decision model was run for
patients with age of 51 that is mean age of screening group. Transition probabilities of moving to each certain
state in 6 month period was determined from Thailand's data and published articles. The cohort was run till
the end of life time. Cost and outcomes were discounted at a 3% annual rate. Extensive sensitivity analysis
was performed.

Results: For semi-annual HCC screening, the incremental cost effectiveness ratio (ICER) which compared with
no screening was 448,125 baht and 544,768 baht per quality adjusted life year (QALY) in male and female
respectively.

Conclusions: AFP with liver ultrasound is not cost effective for semi-annual screening HCC in patients with
hepatitis B surface antigen positive or patients with chronic hepatitis B. according to the Thai threshold that
ICER of cost-effective intervention should not be exceed 300,000 baht per QALY.

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