Supplementary materials: Early-stage hepatocellular carcinoma screening in patients with chronic hepatitis B in China: a cost–effectiveness analysis

These are peer-reviewed supplementary materials for the article 'Early-stage hepatocellular carcinoma screening in patients with chronic hepatitis B in China: a cost–effectiveness analysis' published in the Journal of Comparative Effectiveness Research.Supplementary material 1Supplementary material 2Supplementary material 3Aim: To evaluate the cost–effectiveness of seven screening strategies for chronic hepatitis B (CHB) patients in China. Methods: A discrete event simulation model combining a decision tree and Markov structure was developed to simulate a CHB cohort aged≥40 years on a lifetime horizon and evaluate the costs and health outcomes (quality-adjusted life years [QALYs] gained) of ultrasonography (US), alpha-fetoprotein (AFP), protein induced by vitamin K absence-II (PIVKA-II), AFP+US, AFP+PIVKA-II, GAAD (a diagnostic algorithm based on gender and age combined with results of AFP and PIVKA-II) and GAAD+US. Epidemiologic, clinical performance, utility and cost data were obtained from the literature, expert interviews and real-world data. Uncertainties on key parameters were explored through deterministic and probabilistic sensitivity analyses (DSA and PSA). Results: Compared with other strategies, GAAD+US detected the most HCC patients at early stage, and GAAD was the screening strategy with the lowest average cost per HCC case diagnosed. Using 3× China’s 2022 GDP per capita ($38,233.34) as the threshold, the three strategies of US, GAAD and GAAD+US formed a cost–effectiveness frontier. Screening with US, GAAD, or GAAD+US was associated with costs of $6110.46, $7622.05 and $8636.32, and QALYs of 13.18, 13.48 and 13.52, respectively. The ICER of GAAD over US was $4993.39/QALY and the ICER of GAAD+US over GAAD was $26,691.45/QALY, which was less than 3× GDP per capita. Both DSA and PSA proved the stability of the results. Conclusion: GAAD+US was the most cost-effective strategy for early HCC diagnosis among CHB patients which could be considered as the liver cancer screening scheme for the high-risk population in China.

本数据集为发表在《比较有效性研究杂志》上的文章《中国慢性乙型肝炎患者早期肝细胞癌筛查：成本效益分析》的同行评审补充材料。补充材料1、补充材料2、补充材料3。目标：评估中国慢性乙型肝炎（CHB）患者采用七种筛查策略的成本效益。方法：构建了一个结合决策树和马尔可夫结构的离散事件模拟模型，以模拟≥40岁的CHB队列在终身范围内，并评估超声（US）、甲胎蛋白（AFP）、维生素K缺乏蛋白II型（PIVKA-II）、AFP+US、AFP+PIVKA-II、GAAD（基于性别和年龄结合AFP和PIVKA-II结果的诊断算法）以及GAAD+US的成本和健康结果（获得的调整生命年[QALY]）。流行病学、临床性能、效用和成本数据来源于文献、专家访谈和现实世界数据。通过确定性分析和概率敏感性分析（DSA和PSA）探讨了关键参数的不确定性。结果：与其他策略相比，GAAD+US检测到最多早期HCC患者，GAAD是平均成本最低的筛查策略。以3×中国2022年人均GDP（38,233.34美元）为阈值，超声、GAAD和GAAD+US三种策略形成了成本效益前沿。使用超声、GAAD或GAAD+US进行筛查的成本分别为6110.46美元、7622.05美元和8636.32美元，QALY分别为13.18、13.48和13.52。GAAD相对于US的增量成本效益比（ICER）为4993.39美元/QALY，GAAD+US相对于GAAD的ICER为26,691.45美元/QALY，均低于3×人均GDP。DSA和PSA均验证了结果的稳定性。结论：对于CHB患者的早期HCC诊断，GAAD+US是最具成本效益的策略，可考虑作为中国高风险人群的肝癌筛查方案。