Medical Oncology

, 32:432 | Cite as

Utility and cost-effectiveness of screening for hepatocellular carcinoma in a resource-limited setting

  • Mohamed Eltabbakh
  • Hassan Zaghla
  • Wael Abdel-Razek
  • Hassan Elshinnawy
  • Sameera Ezzat
  • Asmaa Gomaa
  • Imam Waked
Original Paper
First Online:
Received:
Accepted:

Abstract

The utility, efficacy and cost-effectiveness of establishing a prospective screening program for hepatocellular carcinoma (HCC) in a low-cost setting as Egypt has not been previously studied. Eligible patients in this observational study were screened by ultrasound and alpha-fetoprotein (AFP) every 6 months. A focal lesion on ultrasound or AFP >200 ng/ml or significant increase in 6 months indicated a recall. Characteristics of cases detected on screening were compared to patients diagnosed outside the screening program. Of 1,920 eligible patients, 1,286 patients participated and 102 patients (7.9 %) developed HCC, with an annual incidence of 5.3 %. Ninety-one (89.2 %) were BCLC stage 0 or A and 11 (10.8 %) stage D. Ultrasound detected a hepatic focal lesion in 99 patients, of which 74 were confirmed to be HCC, and AFP added another 28 HCC cases. The annual cost of detecting a treatable HCC case by ultrasound was 3,980 EGP (€ 400) and by both ultrasound and AFP 4,645 EGP (€ 500). Adding the cost of treatment, the cost/quality-adjusted life year (QALY) gained was 7,907 EGP (€ 800)/QALY for screening with ultrasound only, and 8,430 EGP (€ 850)/QALY for using both ultrasound and AFP, which in both cases is <50 % of the per capita GDP and <20 % of the accepted cost/QALY for Egypt. Screening for HCC is feasible and is highly cost-effective in a resource-limited setting. Adding AFP to ultrasound increased detection with a trivial addition to cost/QALY.

Keywords

Cost-effectiveness Screening Hepatocellular carcinoma Ultrasonography Alpha-fetoprotein Limited resources 
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Notes

Conflict of interest

M. Eltabakh: None. H. Zaghla: None. W. Abdel-Razek: None related to this work. Travel Grant: Minapharm. H. Elshinnawy: None. S. Ezat: None. A. Gomaa: None related to this work. Travel Grant: Minapharm. I. Waked: None related to this work. Speaker for Hoffman La Roche, MSD, BMS, GSK, Bayer, Gilead, and Minapharm; sat on advisory boards of Janssen, Hoffman La Roche, MSD, GSK; and has acted as investigator in clinical trials for Hoffman La Roche, BMS, GSK, Bayer, and Minapharm.

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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Mohamed Eltabbakh
    • 1
  • Hassan Zaghla
    • 1
  • Wael Abdel-Razek
    • 1
  • Hassan Elshinnawy
    • 1
  • Sameera Ezzat
    • 2
  • Asmaa Gomaa
    • 1
  • Imam Waked
    • 1
  1. 1.Department of Hepatology, National Liver InstituteMenoufiya UniversityShebeen El-KomEgypt
  2. 2.Department of Community and Public Health, National Liver InstituteMenoufiya UniversityShebeen El-KomEgypt

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