Table III.
Comparing the costs of 2 hypothetical screening scenarios for hepatocellular carcinoma (HCC) – Alaska, 1983–2012a
| Costs/benefits without transportation expensesb | Costs/benefits with transportation expensesb | |||
|---|---|---|---|---|
| AFP→USc,d | US-aloned | AFP→USc,d | US-aloned | |
| Analysis without discounting | ||||
| Total cost for cohort (Base Year 2012) | $528,000 | $1,203,000 | $868,000 | $2,517,000 |
| No. of early-tumours detectede | 10 | 14 | 10 | 14 |
| Median (mean) YLG for Cohort | 29.6 (42) | 41.4 (58.8) | 29.6 (42) | 41.4 (58.8) |
| Cost/early-stage tumour detected | $53,000 | $86,000 | $87,000 | $180,000 |
| Cost/YLG at median (mean) | $18,000 ($13,000) |
$29,000 ($20,000) |
$29,000 ($21,000) |
$61,000 ($43,000) |
| Incremental cost-effectiveness ratiosf | ||||
| Extra cost ($)/extra early-tumour detected | $169,000 | $412,000 | ||
| Extra cost ($)/Extra YLG at Median (Mean) | $57,000 ($40,000) | $139,000 ($98,000) | ||
| Analysis with discountingg | ||||
| Total cost for cohort (Base year 2012) | $357,000 | $814,000 | $587,000 | $1,702,000 |
| No. of early-tumours detectede | 10 | 14 | 10 | 14 |
| Median (mean) YLG for Cohort | 27.8 (38.1) | 38.9 (53.3) | 27.8 (38.1) | 38.9 (53.3) |
| Cost/early-stage tumour detection | $36,000 | $58,000 | $59,000 | $122,000 |
| Cost/YLG at median (mean) | $13,000 ($9,400) | $21,000 ($15,000) | $21,000 ($15,000) | $44,000 ($32,000) |
| Incremental cost-effectiveness ratiosf | ||||
| Extra cost ($)/extra early-tumour detected | $114,000 | $279,000 | ||
| Extra cost ($)/extra YLG at median (mean) | $41,000 ($30,000) | $100,000 ($73,000) | ||
AFP, alpha-fetoprotein; HCC, hepatocellular carcinoma; US, ultrasound; YLG, years of life gained.
In a cohort of 839 hepatitis B virus infected AN men aged ≥40 years and women aged ≥50 years.
Total costs rounded to the nearest thousand.
Assumes patients received screening for HCC by serum AFP measurements initially and switched to ultrasound for all subsequent screenings if AFP >10 ng/mL.
Assumes patients received screening for HCC on dates for which AFP measurements were recorded.
Early-tumour if single tumour ≤5 cm in diameter or ≤3 tumours ≤3 cm in diameter; model assumes 33% (4) of tumours identified at a late stage by the AFP→US method were identified by the US-alone method at an early stage.
Ratio=(costs US-alone – costs AFP→US)/(outcome US-alone – outcome AFP→US), where outcomes are the number of early-tumours detected or number YLG by early detection. Treatment costs after the detection of tumour (early or late) are not included in these estimates.
Discounted direct costs of screening and YLG at 3%/year (reference year 2012) over a 30-year time horizon.