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Cost-Effectiveness of Liver Cancer Screening in Adults at High Risk for Liver Cancer in the Republic of Korea

Cancer Research and Treatment 2014년 46권 3호 p.223 ~ p.233

이용화(Lee Young-Hwa) - National Cancer Center National Cancer Control Institute
최귀선(Choi Kui-Son) - National Cancer Center National Cancer Control Institute
전재관(Jun Jae-Kwan) - National Cancer Center National Cancer Control Institute
서미나(Suh Mi-Na) - National Cancer Center National Cancer Control Institute
이후연(Lee Hoo-Yeon) - Dankook University College of Medicine Department of Social Medicine
김윤남(Kim Youn-Nam) - Yonsei University College of Medicine Department of Biostatistics
남정모(Nam Chung-Mo) - Yonsei University College of Medicine Department of Preventive Medicine
박은아(Park Eun-Ah) - Yonsei University College of Medicine Department of Preventive Medicine
조우현(Cho Woo-Hyun) - Yonsei University College of Medicine Department of Preventive Medicine

Abstract

Purpose: This study was conducted in order to determine the most cost-effective strategy, in terms of interval and age range, forliver cancer screening in the high-risk population of Korea.

Materials and Methods: A stochastic modelwas used to simulate the cost-effectiveness ofliver cancer screening by combined ultrasonography and alpha-fetoprotein testing when varying both screening intervals and age ranges. The effectiveness of these screening strategies in the high-risk population was defined as the probability of detecting preclinical liver cancer, and costwas based on the direct cost ofthe screening and confirmative tests. Optimal cost-effectiveness was determined using the incremental cost-effectiveness ratio.

Results: Among the 36 alternative strategies, one-year or two-year interval screening for men aged between 50 and 80 years, six-month or one-year interval screening for men aged between 40 and 80 years, and six-month interval screening for men aged between 30 and 80 years were identified as non-dominated strategies. For women, identified non-dominated strategies were: one-year interval screening between age 50 and 65 years, one-year or six-month interval screening between age 50 and 80 years, six-month interval screening between age 40 and 80 years, and six-month interval screening between age 30 and 80 years.

Conclusion: In Korea, a one-year screening interval for men aged 50 to 80 years would be marginally cost-effective. Further studies should be conducted in order to evaluate effectiveness of liver cancer screening, and compare the cost effectiveness of different liver cancer screening programs with a final outcome indicator such as qualityadjusted life-years or disability-adjusted life-years.