Cost-effectiveness analysis of population-based screening of hepatocellular carcinoma: Comparing ultrasonography with two-stage screening

AIM: To assess the cost-effectiveness of two populationbased hepatocellular carcinoma(HCC) screening programs, two-stage biomarker-ultrasound method and mass screening using abdominal ultrasonography(AUS).METHODS: In this study, we applied a Markov decision model with a societal perspective and a lifetime horizon for the general population-based cohorts in an area with high HCC incidence, such as Taiwan. The accuracy of biomarkers and ultrasonography was estimated from published meta-analyses. The costs of surveillance, diagnosis, and treatment were based on a combination of published literature, Medicare payments, and medical expenditure at the National Taiwan University Hospital. The main outcome measure was cost per lifeyear gained with a 3% annual discount rate. RESULTS: The results show that the mass screening using AUS was associated with an incremental costeffectiveness ratio of USD39825 per life-year gained, whereas two-stage screening was associated with an incremental cost-effectiveness ratio of USD49733 per life-year gained, as compared with no screening. Screening programs with an initial screening age of 50 years old and biennial screening interval were the most cost-effective. These findings were sensitive to the costs of screening tools and the specificity of biomarker screening.CONCLUSION: Mass screening using AUS is more cost effective than two-stage biomarker-ultrasound screening. The most optimal strategy is an initial screening age at 50 years old with a 2-year inter-screening interval.

Application of quantitative estimates of fecal hemoglobin concentration for risk prediction of colorectal neoplasia

AIM:To determine the role of the fecal immunochemical test(FIT),used to evaluate fecal hemoglobin concentration,in the prediction of histological grade and risk of colorectal tumors.METHODS:We enrolled 17881 individuals who attended the two-step colorectal cancer screening program in a single hospital between January 2010 and October 2011.Colonoscopy was recommended to the participants with an FIT of≥12 ngHb/mL buffer.We classified colorectal lesions as cancer(C),advanced adenoma(AA),adenoma(A),and others(O)by their colonoscopic and histological findings.Multiple linear regression analysis adjusted for age and gender was used to determine the association between the FIT results and colorectal tumor grade.The risk of adenomatous neoplasia was estimated by calculating the positive predictive values for different FIT concentrations.RESULTS:The positive rate of the FIT was 10.9%(1948/17881).The attendance rate for colonoscopy was 63.1%(1229/1948).The number of false positive results was 23.Of these 1229 cases,the numbers of O,A,AA,and C were 759,221,201,and 48,respectively.Regression analysis revealed a positive association between histological grade and FIT concentration(β=0.088,P<0.01).A significant log-linear relationship was found between the concentration and positive predictive value of the FIT for predicting colorectal tumors(R2>0.95,P<0.001).CONCLUSION:Higher FIT concentrations are associated with more advanced histological grades.Risk prediction for colorectal neoplasia based on individual FIT concentrations is significant and may help to improve the performance of screening programs.