A Systematic Review and Narrative Synthesis of Health Economic Evaluations of Hepatocellular Carcinoma Screening Strategies

Published:March 04, 2021DOI:


      • Hepatocellular carcinoma (HCC) screening is recommended by professional bodies for early detection of the disease. Many health economic evaluations of HCC screening have been conducted, but there is a lack of synthesized evidence for recent studies.
      • The majority of studies reported HCC screening to be cost-effective and the combination of ultrasound and alpha fetoprotein at 6-month intervals was the most cost-effective strategy. However, several limitations within those studies requires the cost-effectiveness evidence to be interpreted with care.
      • The impact of central adiposity on the precision of ultrasound, real-world utilization rates of screening, and projections of increased HCC incidence were factors that were mostly ignored by the studies included in this review. Future robust studies need to consider these critical parameters to produce more reliable cost-effectiveness evidence for HCC screening.



      Many economic evaluations of hepatocellular carcinoma (HCC) screenings have been conducted; however, these vary substantially with regards to screening strategies, patient group, and setting. This review aims to report the current knowledge of the cost-effectiveness of screening and describe the published data.


      We conducted a search of biomedical and health economic databases up to July 2020. We included full and partial health economic studies if they evaluated the costs or outcomes of HCC screening strategies.


      The review included 43 studies. Due to significant heterogeneity in key aspects across the studies, a narrative synthesis was conducted. Most studies reported using ultrasound or alpha fetoprotein as screening strategies. Screening intervals were mostly annual or biannual. Incidence, diagnostic performance, and health state utility values were the most critical parameters affecting the cost-effectiveness of screening. The majority of studies reported HCC screening to be cost-effective, with the biannual ultrasound + alpha fetoprotein standing out as the most cost-effective strategy. However, few studies considered the utilization rate, and none considered the diagnostic performance of ultrasound in the context of central adiposity. Computed tomography and magnetic resonance imaging were also evaluated, but its cost-effectiveness was still controversial.


      Although many studies suggested HCC screening was cost-effective, substantial limitations of the quality of these studies means the results should be interpreted with caution. Future modeling studies should consider the impact of central adiposity on the precision of ultrasound, real-world utilization rates and projections of increased HCC incidence.


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