Cost‐Utility Analysis of Biomarker‐Based vs. USG + AFP Strategies for HCC Surveillance in Chronic Hepatitis B

Background The standard surveillance for hepatocellular carcinoma (HCC) involves ultrasound (USG) with alpha‐fetoprotein (AFP) every 6 months. However, limitations, such as restricted access, radiologist shortages, and uncertain cost‐effectiveness, persist. Aims We assessed the cost‐effectiveness of traditional and biomarker‐based HCC surveillance strategies in patients with chronic hepatitis B (CHB). Methods A Markov model simulated a cohort of patients with CHB to evaluate the cost‐effectiveness of various surveillance strategies: USG + AFP, GAAD, GALAD, ASAP, and no surveillance. Input parameters were sourced from literature and Thai healthcare data. The analysis adopted a societal perspective and lifetime horizon, calculating incremental cost‐effectiveness ratios (ICERs) in Thai Baht (THB) per quality‐adjusted life year (QALY) gained. Sensitivity analyses assessed robustness. Results ASAP every 6 months was the most cost‐effective strategy, with ICERs of 102,443 THB (~2957 USD) per QALY versus ASAP every 12 months and 76,447 THB (~2207 USD) per QALY versus no surveillance. Although GAAD and GALAD every 6 months achieved similar QALYs, they were dominated due to higher costs. Annual surveillance improved cost‐effectiveness but remained inferior to ASAP every 6 months. USG + AFP every 6 months incurred the highest lifetime cost (166,253 THB, ~4800 USD). Sensitivity analyses confirmed the robustness of ASAP every 6 months, with key drivers including biomarker costs, HCC stage utilities, and incidence rates. Conclusions ASAP every 6 months is the most cost‐effective HCC surveillance strategy for patients with CHB and may be particularly suitable for resource‐limited settings. Biomarker‐based surveillance should be prioritised to improve outcomes and optimise resource use.