Table 1. Model variables (see Supplementary Table S6 for references).
| Variable | Baseline (range tested) |
|---|---|
| Disease progression | |
| Age (years) | 50 (40–60) |
| Cycle time | 6 months |
| Compensated cirrhosis prognosis | |
| Adjusted annual excess mortality of compensated cirrhosis | 4% (1.8–8%) |
| 10-year survival of compensated cirrhosis | 64% (43–80%) |
| Annual probability of transition from compensated to decompensated cirrhosis | 5% (3–8%) |
| Decompensated cirrhosis prognosis | |
| Annual mortality of decompensated cirrhosis | 28% (18–30%) |
| 2-year survival of decompensated cirrhosis | 52% (49–67%) |
| HCC prognosis | |
| Annual mortality of advanced HCC | 75% (30–95%) |
| HCC natural history | |
| Annual HCC probability | 2.9% (0.5–7.0%) |
| Annual probability of progression from small to advanced HCC | 40% (20–70%) |
| Probability of therapy | |
| Probability of HCC in compensated cirrhosis to be treated with surgical resection | 40% (20–60%) |
| Probability of liver transplantation for early HCC in compensated cirrhosis | 20% (0–50%) |
| Probability of local ablation for HCC in decompensated cirrhosis | 40% (20–100%) |
| Probability of treatment of early HCC after identification in compensated cirrhosis | 69% (50–100%) |
| Probability of treatment of early HCC after identification in decompensated cirrhosis | 30% (0–50%) |
| Probability of liver transplantation for early HCC in treatment-eligible decompensated cirrhosis | 40% (0–80%) |
| Probability of local ablation for early HCC in treatment-eligible decompensated cirrhosis | 60% (20–100%) |
| Prognosis after therapy | |
| 5-year survival after hepatic resection for HCC | 44% (38–51%) |
| Perioperative mortality of hepatic resection | 3.9% (3.7–4.5%) |
| 5-year survival after liver transplantation for HCC | 70% (65–80%) |
| Perioperative mortality of liver transplantation | 4.3% (2.3–6.3%) |
| 5-year survival after local ablation for HCC in compensated cirrhosis | 46% (32–77%) |
| 5-year survival after local ablation for HCC in decompensated cirrhosis | 31% (27–40%) |
| Perioperative mortality of local ablation | 0.3% (0–1.8%) |
| HCC risk score | |
| 186-gene-based risk score, proportion of each risk group | High: 36% (0–50%) Intermediate: 37% Low: 27% (10–50%) |
| 186-gene-based risk score, annual HCC incidence in each risk group | High: 4.9% (0.8–12%) Intermediate: 3.3% (0.6–8.0%) Low: 0.8% (0.1–1.9%) |
| EGF genotype-based risk score, proportion of each risk group | High: 14% (0–40%) Intermediate: 29% Low: 57% (0–60%) |
| EGF genotype-based risk score, annual HCC incidence in each risk group | High: 5% (2.5–10%) Intermediate: 1.8% (0.9–3.6%) Low: 0.4% (0.2–0.8%) |
| Screening and diagnosis test characteristics | |
| Probability of being screened for HCC | 100% (15–100%) |
| Reported probability of being screened for HCC | 15% (5–60%) |
| Probability of incidental early HCC in the non-screened group | 30% (0–50%) |
| Ultrasound sensitivity for early-stage HCC screening | 63% (35–78%) |
| Ultrasound specificity for early-stage HCC screening | 91% (70–95%) |
| Screening full MRI sensitivity for early-stage HCC screening | 96% (80–100%) |
| Screening full MRI specificity for early-stage HCC screening | 94% (85–98%) |
| Abbreviated MRI sensitivity for early-stage HCC screening | 83% (70–95%) |
| Abbreviated MRI specificity for early-stage HCC screening | 93% (86–96%) |
| Diagnostic MRI sensitivity for early-stage HCC | 88% (78–92%) |
| Diagnostic MRI specificity for early-stage HCC | 94% (85–98%) |
| HCC biopsy sensitivity | 62% (50–100%) |
| HCC biopsy specificity | 100% (80–100%) |
| Costs ($) | Medicare, National Impatient Sample |
| Annual cost of compensated cirrhosis | 1,220 (610–2,440) |
| Annual cost of decompensated cirrhosis | 15,000 (7,500–30,000) |
| Annual cost after liver transplantation | 14,600 (7,300–29,200) |
| Annual cost of advanced HCC | 41,320 (20,660–82,640) |
| Cost of hepatic resection | 42,540 (21,270–85,080) |
| Cost of liver transplantation | 177,000 (88,500–354,000) |
| Cost of local ablation | 3,650 (1,825–7,300) |
| Cost of imaging-guided HCC biopsy | 750 (375–1,500) |
| Cost of ultrasound | 143 (71–285) |
| Cost of screening full MRI | 528 (264–1,056) |
| Cost of screening abbreviated MRI | 313 (156–626) |
| Cost of diagnostic MRI | 528 (264–528) |
| Cost of risk score | 796 (500–4,000) |
| Rate of discounting costs | 3% |
| Quality-of-life weights | |
| Utility of compensated cirrhosis | 0.8 (0.6–1.0) |
| Utility of decompensated cirrhosis | 0.65 (0.5–0.8) |
| Utility after HCC diagnosis | 0.3 (0.1–0.4) |
| Utility after liver transplantation | 0.73 (0.5–0.8) |
AMRI, abbreviated MRI; EGF, epidermal growth factor; HCC, hepatocellular carcinoma; MRI, magnetic resonance imaging.