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Background <p>In China, a significant number of individuals with chronic hepatitis B (CHB) are at risk of developing hepatocellular carcinoma (HCC). Due to low surveillance rates and guidelines that inadequately address resource constraints, this study evaluates the cost-effectiveness of risk-based HCC surveillance strategies in CHB patients in China.</p> Methods <p>We developed a state-transition model to simulate disease progression in hypothetical CHB cohorts over their lifetimes, considering various HCC risk scores to classify patients into low, intermediate, and high-risk categories. The model assessed the cost-effectiveness of five active surveillance strategies, including biannual monitoring, compared to no surveillance. Key outcomes included life expectancy, quality-adjusted life years (QALYs), total costs, and the incremental cost-effectiveness ratio (ICER), with comparisons to China’s willingness-to-pay (WTP) threshold of $37,674 per QALY.</p> Results <p>For overall and intermediate-risk cohorts, biannual and annual surveillance were cost-effective (ICER &lt; $37,674/QALY). In high-risk groups, all surveillance strategies, except quinquennial, were cost-effective, with ICERs ranging from $28,448 to $36,073 per QALY. No surveillance strategy was cost-effective for the low-risk group. Sensitivity analyses confirmed biannual surveillance had the highest probability of being cost-effective across all risk groups and was most sensitive to changes in mortality rates associated with intermediate to advanced HCC stages.</p> Conclusions <p>The cost-effectiveness of HCC surveillance in CHB patients varies based on HCC risk. A risk-stratified approach, with biannual surveillance prioritized for high-risk patients and potentially omitted for low-risk patients, could optimize resource allocation.</p>

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Cost-Effectiveness of Risk-Score-Based Surveillance Strategies for Hepatocellular Carcinoma in Patients with Chronic Hepatitis B

  • 期刊论文

  • 发表日期：

    2025年9月27日

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  • Ying Chen,
  • Hao Feng,
  • Yun Bao,
  • Mengxia Yan,
  • Kaijie Yao,
  • Bin Wu

摘要

Background

In China, a significant number of individuals with chronic hepatitis B (CHB) are at risk of developing hepatocellular carcinoma (HCC). Due to low surveillance rates and guidelines that inadequately address resource constraints, this study evaluates the cost-effectiveness of risk-based HCC surveillance strategies in CHB patients in China.

Methods

We developed a state-transition model to simulate disease progression in hypothetical CHB cohorts over their lifetimes, considering various HCC risk scores to classify patients into low, intermediate, and high-risk categories. The model assessed the cost-effectiveness of five active surveillance strategies, including biannual monitoring, compared to no surveillance. Key outcomes included life expectancy, quality-adjusted life years (QALYs), total costs, and the incremental cost-effectiveness ratio (ICER), with comparisons to China’s willingness-to-pay (WTP) threshold of $37,674 per QALY.

Results

For overall and intermediate-risk cohorts, biannual and annual surveillance were cost-effective (ICER < $37,674/QALY). In high-risk groups, all surveillance strategies, except quinquennial, were cost-effective, with ICERs ranging from $28,448 to $36,073 per QALY. No surveillance strategy was cost-effective for the low-risk group. Sensitivity analyses confirmed biannual surveillance had the highest probability of being cost-effective across all risk groups and was most sensitive to changes in mortality rates associated with intermediate to advanced HCC stages.

Conclusions

The cost-effectiveness of HCC surveillance in CHB patients varies based on HCC risk. A risk-stratified approach, with biannual surveillance prioritized for high-risk patients and potentially omitted for low-risk patients, could optimize resource allocation.