Antiviral therapy for hepatitis B-related liver cancer prevention is more cost-effective than cancer screening

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Journal of Hepatology

Volume 50, Issue 5, May 2009, Pages 990-998

Antiviral therapy for hepatitis B-related liver cancer prevention is more

cost-effective than cancer screening

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C. Robotin1, 2, , , Kansil3, Kirsten 2, 4, 5,

Tipper1, J. Dore6, Miriam Levy7 and G. Penman8

1The Cancer Council NSW, Research Strategy and Scientific Development Unit, 153

Dowling St, Woolloomooloo, NSW 2011, Sydney, Australia

2University of Sydney, School of Public Health, Ford Building A27,

University of Sydney, NSW, Australia

3Pacific Strategy Partners, Woolloomooloo, NSW, Australia

4University of Sydney, School of Medicine, NSW, Australia

5Storr Liver Unit, Westmead Hospital, Department of Medicine, Westmead Hospital,

Westmead, NSW, Australia

6National Centre in HIV Epidemiology and Clinical Research, University of New

South Wales, Darlinghurst, NSW, Australia

7Liverpool Hospital, Department of Gastroenterology, NSW, Australia

8The Cancer Council NSW, Unit of the CEO, Woolloomooloo, NSW, Sydney, Australia

Received 25 August 2008; revised 19 December 2008; accepted 29 December 2008.

Associate Editor: J.M. Llovet. Available online 15 February 2009.

Background/Aims

In Australia, Asian-born populations are 6–12 times more likely to develop

hepatocellular cancer (HCC) than Australian-born individuals. We therefore,

modelled the consequences of different management strategies for chronic

hepatitis B (CHB) in Asian-born adults aged 35 years.

Methods

A Markov model compared (1) enhanced surveillance for HCC alone (HCC

surveillance), or (2) enhanced HCC surveillance coupled with CHB treatment (HCC

prevention) to the current practice, of low CHB treatment uptake. Patients were

stratified and managed according to risk categories, based upon hepatitis B

virus (HBV) viral load and alanine aminotransferase (ALT) levels. We measured

costs, health outcomes [cases of HCC and deaths averted, quality-adjusted

life-years (QALYs) gained] and incremental cost-effectiveness ratios (ICERs).

Results

HCC surveillance would cost on average AU$8479 per person, compared to AU$2632

with current clinical practice and result in a gain of 0.014 QALYs

(AU$401,516/QALY gained). A HCC prevention strategy would cost on average

AU$14,600 per person, result in 0.923 QALYs gained (AU$12,956/QALY gained),

reduce cases of cirrhosis by 52%, HCC diagnoses by 47% and CHB-related deaths by

56%, compared to current practice.

Conclusions

HCC prevention appears to be a cost-effective public health strategy in at-risk

populations in Australia and is preferable to HCC surveillance as a cancer

control strategy.