Table 1.
Model Input Parameters
| Input Variable | Value | Range | References |
|---|---|---|---|
| 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) |