Table 2. Cost-effectiveness of non-stratified and risk-stratified HCC screening strategies.
| Strategy | QALE | Cost | ICER | ICER |
|---|---|---|---|---|
| (vs. US2 × -100%) | (vs. US2 × -15%) | |||
| No screening | 6.40 | $42,961 | ||
| Reference strategies | ||||
| Regular US screening (100% adherence; US2 × -100%) | 6.51 | $51,761 | Reference | |
| Regular US screening (15% adherence; US2 × -15%) | 6.39 | $44,078 | Reference | |
| Non-stratified experimental strategies | ||||
| MRI for all (MRI-100%) | 6.57 | $56,871 | 85,167 | 71,072 |
| AMRI for all (AMRI-100%) | 6.55 | $53,883 | 53,050 | 61,281 |
| Risk-stratified strategies (for high–intermediate–low risk groups) | ||||
| US4 × -US2 × -US2 × | 6.50 | $54,601 | Dominated | 95,664 |
| MRI-US2 × -US2 × | 6.54 | $54,442 | 89,367 | 69,093 |
| AMRI-US2 × -US2 × | 6.53 | $53,437 | 83,800 | 66,850 |
| US2 × -US2 × -none | 6.52 | $50,417 | Dominant | 48,762 |
| US4 × -US4 × -none | 6.51 | $54,391 | Dominated | 85,942 |
| MRI-MRI-none | 6.58 | $53,966 | 31,500 | 52,042 |
| AMRI-AMRI-none | 6.56 | $51,866 | 2,100 | 45,812 |
| US4 × -US2 × -none | 6.52 | $52,300 | 53,900 | 63,246 |
| MRI-US2 × -none | 6.55 | $52,140 | 9,475 | 50,388 |
| AMRI-US2 × -none | 6.54 | $51,136 | Dominant | 47,053 |
| US2 × -none-none | 6.48 | $47,086 | Less effective | 33,422 |
| US4 × -none-none | 6.47 | $48,969 | Less effective | 61,137 |
| MRI-none-none | 6.51 | $48,809 | Dominant | 39,425 |
| AMRI-none-none | 6.50 | $47,804 | Less effective | 33,873 |
AMRI, abbreviated magnetic resonance imaging; HCC, hepatocellular carcinoma; ICER, incremental cost-effectiveness ratio; QALE, quality-adjusted life expectancy; US, ultrasound. Dominant, improved QALE with lower cost; dominated, worse QALE with higher cost; less effective, reduced efficacy with lower cost; 2/4 ×, screening two/four times a year; MRI and AMRI are biannual. Risk-stratified strategies are named as screening modality in high-risk subjects–intermediate-risk subjects–low-risk subjects. For example, MRI-none-none corresponds to screening by MRI in high-risk subjects and no screening in intermediate- and low-risk subjects.