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Cost-effectiveness analysis of a two-stage screening intervention for hepatocellular carcinoma in Taiwan

Ting-Fang Shih, Sophy, Crowley, Steve and Sheu, Jin-Chuan 2010, Cost-effectiveness analysis of a two-stage screening intervention for hepatocellular carcinoma in Taiwan, Journal of the Formosan Medical Association, vol. 109, no. 1, pp. 39-55.

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Title Cost-effectiveness analysis of a two-stage screening intervention for hepatocellular carcinoma in Taiwan
Author(s) Ting-Fang Shih, Sophy
Crowley, Steve
Sheu, Jin-Chuan
Journal name Journal of the Formosan Medical Association
Volume number 109
Issue number 1
Start page 39
End page 55
Publisher Scientific Communications International Ltd.
Place of publication Hong Kong, China
Publication date 2010-01
ISSN 0929-6646
Keyword(s) cost effectiveness
hepatocellular carcinoma
mass screening
modeling
Summary Background/Purpose

Hepatocellular carcinoma (HCC) has been the leading cause of cancer death in Taiwan since the 1980s. A two-stage screening intervention was introduced in 1996 and has been implemented in a limited number of hospitals. The present study assessed the costs and health outcomes associated with the introduction of screening intervention, from the perspective of the Taiwanese government. The cost-effectiveness analysis aimed to assist informed decision making by the health authority in Taiwan.
Methods

A two-phase economic model, 1-year decision analysis and a 60-year Markov simulation, was developed to conceptualize the screening intervention within current practice, and was compared with opportunistic screening alone. Incremental analyses were conducted to compare the incremental costs and outcomes associated with the introduction of the intervention. Sensitivity analyses were performed to investigate the uncertainties that surrounded the model.
Results

The Markov model simulation demonstrated an incremental cost-effectiveness ratio (ICER) of NT$498,000 (US$15,600) per life-year saved, with a 5% discount rate. An ICER of NT$402,000 (US$12,600) per quality-adjusted life-year was achieved by applying utility weights. Sensitivity analysis showed that excess mortality reduction of HCC by screening and HCC incidence rates were the most influential factors on the ICERs. Scenario analysis also indicated that expansion of the HCC screening intervention by focusing on regular monitoring of the high-risk individuals could achieve a more favorable result.
Conclusion

Screening the population of high-risk individuals for HCC with the two-stage screening intervention in Taiwan is considered potentially cost-effective compared with opportunistic screening in the target population of an HCC endemic area.
Language eng
Field of Research 111202 Cancer Diagnosis
140208 Health Economics
160508 Health Policy
Socio Economic Objective 920207 Health Policy Economic Outcomes
HERDC Research category C1 Refereed article in a scholarly journal
Copyright notice ©2010 Elsevier & Formosan Medical Association
Persistent URL http://hdl.handle.net/10536/DRO/DU:30028667

Document type: Journal Article
Collection: Public Health Research, Evaluation, and Policy Cluster
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Created: Tue, 25 May 2010, 09:31:52 EST by Deborah Wittahatchy