University Of Tasmania

File(s) under permanent embargo

A systematic review and narrative synthesis of health economic evaluations of Hepatocellular Carcinoma (HCC) screening strategies

Objectives: Many economic evaluations of hepatocellular carcinoma (HCC) screening have been conducted, however these vary substantially with regards to screening strategies, patient group and setting. This review aims to report the current knowledge of the cost-effectiveness of screening and describe the published data.

Methods: We conducted a search of biomedical and health economic databases up to July, 2020. We included full and partial health economic studies if they evaluated the costs and/or outcomes of HCC screening strategies.

Results: The review included 43 studies. Due to significant heterogeneity in key aspects across the studies, a narrative synthesis was conducted. Most studies reported using ultrasound and/or alpha fetoprotein (AFP) as screening strategies. Screening intervals were mostly annual or biannual. Incidence, diagnostic performance and health state utility values (HSUVs) were the most critical parameters affecting the cost-effectiveness of screening. The majority of studies reported HCC screening to be cost-effective, with the biannual ultrasound+AFP standing out as the most cost-effective strategy. However, few studies considered the utilisation rate, and none considered the diagnostic performance of ultrasound in the context of central adiposity. Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) were also evaluated, but its cost-effectiveness was still controversial.

Conclusion: Whilst many studies suggested HCC screening was cost-effective, substantial limitations of the quality of these studies means the results should be interpreted with caution. Future modelling studies should take into account the impact of central adiposity on the precision of ultrasound, real-world utilisation rates and projections of increased HCC incidence.


Publication title

Value in Health






Menzies Institute for Medical Research


Blackwell Publishing Inc

Place of publication

350 Main St, Malden, USA, Ma, 02148

Repository Status

  • Restricted

Socio-economic Objectives

Public health (excl. specific population health) not elsewhere classified