Display Settings:

Format

Send to:

Choose Destination
See comment in PubMed Commons below
Clin Transplant. 2011 Mar-Apr;25(2):283-91. doi: 10.1111/j.1399-0012.2010.01212.x.

Cost-effectiveness of screening for recurrent hepatocellular carcinoma after liver transplantation.

Author information

  • 1Division of Gastroenterology, Department of Medicine, University of California, San Francisco, CA 94143-0538, USA. uri.ladabaum@stanford.edu

Abstract

The effectiveness of screening and treatment of recurrent hepatocellular carcinoma (HCC) after liver transplantation (LT) remains undefined. Our aim was to evaluate the potential cost-effectiveness of screening for recurrent HCC after LT. We constructed a Markov model of the natural history after LT for HCC. We superimposed screening with computed tomography, alpha-fetoprotein, and chest X-ray every six months for 1-5 yr after LT, with resection for treatable recurrence. Screening only those whose explant pathology exceeded Milan Criteria (MC) for two yr cost $ 138,000/life-yr gained, and the incremental cost of screening all patients was $ 340,000/life-yr gained. Screening for longer than two yr incurred progressively higher incremental costs/life-yr gained. The most critical variable in sensitivity analyses was the survival benefit of finding a resectable recurrence. With the most favorable assumptions for a two-yr screening duration, screening those whose explant pathology exceeded MC cost $ 91,000/life-yr gained. In conclusion, screening for HCC recurrence after LT would probably yield most of its benefit in the first two yr, but at a relatively high cost/life-yr gained. Screening for two yr in only those whose explant pathology exceeds MC may be relatively cost-effective depending on the survival benefit of resection.

© 2010 John Wiley & Sons A/S.

PMID:
20156221
[PubMed - indexed for MEDLINE]
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Icon for Blackwell Publishing
    Loading ...
    Write to the Help Desk