PMID: 9424649Jul 1, 1997Paper

Screening for the early diagnosis of hepatocellular carcinoma: cost-effectiveness analysis

La Radiologia medica
L BolondiF Piscaglia

Abstract

We investigated the cost-effectiveness of a screening program for the early diagnosis and treatment of hepatocellular carcinoma (HCC) in liver cirrhosis patients. An HCC screening program in liver cirrhosis patients should be carried out when the HCC makes a major cause of death and considering that: 1) the diagnostic techniques should be highly sensitive and specific; 2) the overall cost of the screening program should not be too high; 3) patient survival should be improved. March, 1989, to November 1991, 324 Italian patients with liver cirrhosis (201 men and 123 women) whose age ranged 18-83 years (mean +/- SD: 57.2 +/- 11.9) were submitted to US examinations and serum alpha-fetoprotein titration at six months' intervals. During the follow-up, 38 patients (11.7%) developed HCC, with 4.3% incidence per follow-up year. The Cox model identified serum alpha-fetoprotein, Child-Pugh classes B and C and the male gender as independent risk factors for developing HCC. Only 22 of 38 HCC patients (58%) were submitted to resection, orthotopic liver transplantation or local therapy. The 3-year survival of the 38 HCCs diagnosed during the follow-up is 37%. In all, 1800 US examinations and serum alpha-fetoprotein titrations were carried out...Continue Reading

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