# Economic evaluation of biomarker-based surveillance for Hepatocellular Carcinoma in Thai patients with Compensated Liver Cirrhosis

## TL;DR

This study evaluates the cost-effectiveness of biomarker-based HCC screening in Thai patients with liver cirrhosis, finding that the GAAD score is a cost-effective alternative to current methods.

## Contribution

The study introduces and evaluates the GAAD biomarker score as a novel, cost-effective HCC surveillance method for Thai patients with compensated liver cirrhosis.

## Key findings

- GAAD surveillance is cost-effective with an ICER of $4,631 compared to no surveillance.
- GAAD is dominant over ultrasound plus AFP, offering better health outcomes at lower cost.
- Bi-annual HCC surveillance is cost-effective for Thai patients with CLC.

## Abstract

Hepatocellular carcinoma (HCC) is the leading cause of cancer-related death in Thailand. However, most Thai patients at high risk of HCC lack access to routine surveillance programs. This study used ultrasound- or biomarker-based screening approaches to assess the cost-utility analysis of routine HCC surveillance in patients with compensated liver cirrhosis (CLC).

The model utilized a Markov-style microsimulation framework to simulate outcomes from alternative HCC surveillance methods for Thai patients. The model was designed to represent Thai patients and healthcare as accurately as possible, and novel Thai patient data was used to estimate treatment and survival associated with screening. Outcomes included diagnostic performance, total costs, and overall health expressed as quality-adjusted life years (QALYs). The incremental cost-effectiveness ratio (ICER) was assessed according to the Thai willingness-to-pay threshold (฿160,000 = 4,800 USD).

Results suggest that routine HCC surveillance is likely cost-effective in Thai patients with CLC. Among the biomarker-based approaches, GAAD score, which combined gender, age, alpha-fetoprotein (AFP), and des-gamma carboxyprothrombin (DCP), was the most cost-effective due to its high detection of HCC while resulting in comparably few false positive diagnoses. Compared to no routine surveillance, GAAD surveillance is suggested to be cost-effective (ICER: $4,631). Compared to ultrasound plus AFP – the recommended standard of care – GAAD is suggested to be dominant, resulting in better overall health at a lower cost.

Bi-annual routine HCC surveillance is suggested to be cost-effective for the Thai healthcare system when used for patients with CLC. Among biomarker-based approaches, GAAD appears to be the most cost-effective and could maximize the benefits of HCC surveillance in high-risk patients.