Utilizing a Markov model developed via TreeAge Pro software, Paulo Henrique Lima, An Tang, and a team of researchers at the University of Montreal simulated seven strategies for surveilling and diagnosing hepatocellular carcinoma (HCC) in patients with cirrhosis: ultrasound (US) for surveillance, CT for diagnosis; US for surveillance, complete MRI for diagnosis; US for surveillance, CT for inadequate or positive surveillance; US for surveillance, complete MRI for inadequate or positive surveillance; surveillance and diagnosis with CT, followed by complete MRI for inadequate surveillance; surveillance and diagnosis with complete MRI, followed by CT for inadequate surveillance; and surveillance with abbreviated MRI, followed by CT for inadequate surveillance or complete MRI for positive surveillance. For both compliance scenarios evaluated—optimal and conservative—the most cost-effective strategy was based upon a willingness-to-pay threshold of $50,000 (Canadian) per quality adjusted life year. Base-case analysis revealed that the most cost effective strategy when compliance was optimal was surveillance and diagnosis with CT, followed by complete MRI for inadequate surveillance. When compliance was conservative, the best option was surveillance with abbreviated MRI, followed by CT for inadequate surveillance or complete MRI for positive surveillance. Although sensitivity analyses supported the base-case analysis in the optimal compliance scenario, several parameters altered cost effectiveness in the conservative scenario. “North American guidelines currently recommend [US] surveillance every 6 months in patients at risk for HCC,” as noted by Health Imaging; however, Lima et al. pointed out that compliance is “suboptimal” with an overall rate of 52%.
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