Economic evaluation of biomarker-based surveillance for Hepatocellular Carcinoma in Thai patients with Compensated Liver Cirrhosis
1
Issued Date
2026-01-01
Resource Type
eISSN
19326203
Scopus ID
2-s2.0-105026638732
Pubmed ID
41490253
Journal Title
Plos One
Volume
21
Issue
1 January
Rights Holder(s)
SCOPUS
Bibliographic Citation
Plos One Vol.21 No.1 January (2026)
Suggested Citation
Pinjaroen N., Pan-Ngum W., Poovorawan K., Wastlund D., Mueller F., Lu P., Shu Yu R.S., Tangkijvanich P. Economic evaluation of biomarker-based surveillance for Hepatocellular Carcinoma in Thai patients with Compensated Liver Cirrhosis. Plos One Vol.21 No.1 January (2026). doi:10.1371/journal.pone.0337913 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/114408
Title
Economic evaluation of biomarker-based surveillance for Hepatocellular Carcinoma in Thai patients with Compensated Liver Cirrhosis
Corresponding Author(s)
Other Contributor(s)
Abstract
Objective 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). Method 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 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. Conclusion 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.