Hepatocellular Carcinoma Incidence |
Incidence in compensated cirrhosis (yearly) |
2% |
1%–3% |
(22, 36–38) |
Incidence in decompensated cirrhosis (yearly) |
4% |
2%–6% |
(22, 36–38) |
Screening effectiveness and Diagnostics |
Sensitivity of ultrasound alone for > early stage HCC |
84% |
76%–92% |
(21) |
Sensitivity of ultrasound alone for early stage HCC |
45% |
30%–62% |
(21) |
Specificity of ultrasound alone |
91% |
86%–94% |
(21) |
Sensitivity of US with AFP for > early stage HCC |
97% |
91%–99% |
(21) |
Sensitivity of US with AFP for early HCC |
63% |
48%–75% |
(21) |
Specificity of US with AFP |
84% |
77%–89% |
(21) |
Ultrasound leads to CT/MRI due to false positive |
12% |
8%–16% |
(13, 14) |
AFP leads to CT/MRI because of a false positive |
8% |
5%–11% |
(13, 14) |
Number of CT/MRI completed prior to diagnosis of HCC |
1.5 |
1–3 |
(13, 14) |
Number of CT/MRI completed without diagnosis of HCC for false positive AFP |
1.2 |
1.0–1.5 |
(14) |
Number of CT/MRI completed without diagnosis of HCC for false positive US |
2.5 |
2–4 |
(13, 14) |
Proportion of patients biopsied |
0.3% |
0.1%–0.5% |
(13, 14) |
Biopsy bleeding or biliary injury |
0.6% |
0.3%–0.9% |
(14) |
Death from biopsy |
0.08% |
0.04%–.10% |
(14) |
Biopsy false negative |
30% |
22%–36% |
(14) |
Disease Progression |
Decompensated cirrhosis to palliative care (annually) |
4% |
2%–10% |
(39) |
Advanced HCC to palliative care (annually) |
70% |
60%–80% |
(40) |
Early stage HCC to intermediate stage HCC (no treatment; annual) |
5% |
3%–9% |
(41) |
Intermediate stage HCC to advanced stage HCC (no treatment; annual) |
15% |
12%–18% |
(42) |
Transplant |
Liver transplant for HCC (probability at 6 months) |
14.1% |
10%–18% |
(43) |
Liver transplant for HCC (probability at 12 months) |
60% |
20%–80% |
(43) |
Liver transplant for HCC (probability at 24 months) |
90.6% |
75%–100% |
(43) |
Liver transplant wait time |
4.2 months |
1.6–7.7 months |
(44) |
Costs (2018 US Dollars) |
Abdominal US |
$142.35 |
133.31–194.52 |
(45) |
AFP |
$18.64 |
$16.32–$20.71 |
(46) |
MRI Abdomen with and without contrast |
$498.78 |
$441.32–$648.29 |
(45) |
CT Abdomen with and without contrast |
$273.54 |
$236.67–$346.40 |
(45) |
Liver Biopsy |
$1,034.87 |
$846.05–$1223.70 |
(45) |
Liver biopsy complications |
$5,449 |
$1,385–$35,273 |
(47) |
Liver transplant (first year) |
$354,672 |
$283,543–$364,672 |
(45, 48) |
Liver transplant (after first year) |
$49,906 |
$44,814–$54,447 |
(45, 48) |
HCC early stage costs (annual) |
$64,798 |
$35,512–$131,951 |
(49) |
HCC intermediate stage costs (annual) |
$93,522 |
$42,091–$168,287 |
(49) |
HCC advanced stage costs (annual) |
$84,405 |
$36,480–$115,797 |
(49) |
Compensated cirrhosis costs (annual) |
$26,024 |
$5,157–$312,287 |
(50) |
Decompensated cirrhosis costs (annual) |
$68,604 |
$13,810–$823,248 |
(50) |
Palliative care costs (daily) |
$193 |
$151–$744 |
(51) |
Utilities |
HCC early stage |
0.72 |
0.62–0.82 |
(52) |
HCC intermediate stage |
0.69 |
0.62–0.78 |
(53), (52) |
HCC advanced stage |
0.65 |
0.52–0.78 |
(53), (52) |
Compensated cirrhosis |
0.78 |
0.71–0.89 |
(53), (52) |
Decompensated cirrhosis |
0.60 |
0.46–0.71 |
(53), (52) |
Decompensated cirrhosis and HCC |
0.57 |
0.46–0.68 |
(53), (52) |
Post-Liver transplant (year 1) |
0.69 |
0.55–0.78 |
(54) |
Post-Liver transplant (subsequent years) |
0.79 |
0.62–0.91 |
(54) |
Palliative Care |
0.40 |
0.37–0.42 |
(55) |