Screening for hepatocellular carcinoma (HCC): Is it cost-effective?

Abstract

Hepatocellular carcinoma (HCC) killed 1286 people in 1996 in Hong Kong. It is the second most common cancer death for men and the fourth for women. Over 90% of HCC occur after the age of 40 and 84% are in chronic hepatitis B carriers. The only cure for HCC is surgical resection when it is small. This article applies current evidence to our local epidemiological data to estimate the cost-effectiveness of different HCC screening programmes for hepatitis B carriers aged 40 to 69. The estimated number of persons needed to screen (NNT) for 30 years is 16 for men and 44 for women and the cost is HK$1.30 million for men and HK$3.56 million for women per life saved by four-monthly ultrasonography and serum alpha foetal protein (α-FP) screening. The cost per life saved is lower for the less intensive screening programmes but some potentially preventable HCC deaths may be missed. HCC screening for chronic hepatitis B carriers is more cost-effective than mammogram screening and is comparable to cervical cancer screening. Screening for HCC satisfies nearly all the principles for screening, but its effectiveness and feasibility have to be proven by further clinical trials.