Economic Evaluation and Budget Impact Analysis of the Surveillance Program for Hepatocellular Carcinoma in Thai Chronic Hepatitis B Patients


Background: The incidence rate and the treatment costs of hepatocellular carcinoma (HCC) are high,especially in Thailand. Previous studies indicated that early detection by a surveillance program could help bydown-staging. This study aimed to compare the costs and health outcomes associated with the introduction of aHCC surveillance program with no program and to estimate the budget impact if the HCC surveillance programwere implemented. Materials and
Methods: A cost utility analysis using a decision tree and Markov models wasused to compare costs and outcomes during the lifetime period based on a societal perspective between alternativeHCC surveillance strategies with no program. Costs included direct medical, direct non-medical, and indirectcosts. Health outcomes were measured as life years (LYs), and quality adjusted life years (QALYs). The resultswere presented in terms of the incremental cost-effectiveness ratio (ICER) in Thai THB per QALY gained. Onewayand probabilistic sensitivity analyses were applied to investigate parameter uncertainties. Budget impactanalysis (BIA) was performed based on the governmental perspective.
Results: Semi-annual ultrasonography(US) and semi-annual ultrasonography plus alpha-fetoprotein (US plus AFP) as the first screening for HCCsurveillance would be cost-effective options at the willingness to pay (WTP) threshold of 160,000 THB per QALYgained compared with no surveillance program (ICER=118,796 and ICER=123,451 THB/QALY), respectively.The semi-annual US plus AFP yielded more net monetary benefit, but caused a substantially higher budget (237to 502 million THB) than semi-annual US (81 to 201 million THB) during the next ten fiscal years.
Conclusions:Our results suggested that a semi-annual US program should be used as the first screening for HCC surveillanceand included in the benefit package of Thai health insurance schemes for both chronic hepatitis B males andfemales aged between 40-50 years. In addition, policy makers considered the program could be feasible, butadditional evidence is needed to support the whole prevention system before the implementation of a strategicplan.