Economic Evaluation and Budget Impact Analysis of the Surveillance Program for Hepatocellular Carcinoma in Thai Chronic Hepatitis B Patients

Sangmala, P.; Chaikledkaew, Usa; Tanwandee, Tawesak; Pongchareonsuk, Petcharat

doi:10.7314/apjcp.2014.15.20.8993

Cited by 16 publications

(22 citation statements)

References 67 publications

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“…After implementing this strategy, the adherence rate improved from 52% to 99.9% in later visits (unpublished data). Lastly, the present data support our previous economic evaluation and budget impact analysis[31]. Semi-annual AUS was a cost-effective option for HCC screening and surveillance in CHB patients aged 40-50 years, at a willingness-to-pay threshold of 160000 Thai Baht per quality adjusted life years.…”

Section: Discussionsupporting

confidence: 86%

Hepatocellular carcinoma screening and surveillance in 2293 chronic hepatitis B patients in an endemic area

Ungtrakul¹,

Mahidol²,

Chun-on³

et al. 2016

WJG

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AIMTo determine the role of screening and surveillance of hepatocellular carcinoma (HCC) in treatment-naïve chronic hepatitis B (CHB) patients.METHODSWe recruited 2293 CHB patients (both males and females; aged 20-65 years). All patients were screened and underwent surveillance using abdominal ultrasonography (AUS) and serum alpha-fetoprotein (AFP) assay every 6 mo. The diagnosis, staging and treatment of HCC followed the American Association for the Study of Liver Diseases practice guidelines and the Barcelona Clinic Liver Cancer guidelines. The exclusion criteria included: decompensated cirrhosis; a history of any cancer in the last 5 years; previous antiviral treatment for CHB; concurrent infection with hepatitis C virus or human immunodeficiency virus; a Karnofsky Performance Status score < 60%; or any medical condition preventing eligibility to complete the protocol. The prevalence and incidence rates of HCC were determined; survival rates were calculated at 3-year post HCC diagnosis. The sensitivity and specificity were calculated on a per-patient basis.RESULTSAmong 2293 treatment-naïve CHB patients, seven cases had HCC at initial screening, giving a prevalence rate of 305 per 100000 persons; 3.3% were diagnosed with liver cirrhosis, all of which were Child-Pugh class A. With a median follow-up time of 42 (range, 3-48) mo, 10 additional cases were diagnosed with HCC, resulting in an incidence rate of 143 per 100000 persons per year. This burden was as high as that reported in other studies from East Asian countries. All HCC patients were aged ≥ 40 years. Most were at an early stage (Stage 0, A or B); 14/17 cases were successfully treated with surgical resection or radiofrequency ablation, with a high 3-year survival rate of 90%. Hemangioma was the most common focal liver lesion in CHB patients detected by AUS; the main causes of AFP elevation at the initial screening were cirrhosis, increased alanine aminotransferase level and HCC. AUS detected 16/17 HCC cases whereas AFP levels ≥ 20 μg/L at diagnosis were observed in only 7/17 patients, most with a tumor size > 5 cm. For HCC screening and surveillance, AUS had a sensitivity and specificity of 94% and 82%, respectively, whereas the sensitivity and specificity of AFP at a cut-off value of ≥ 20 μg/L were 41% and 98%, respectively. Combined use of AUS and AFP assay did not improve effectiveness.CONCLUSIONImplementation of active screening and surveillance using AUS to detect early-stage HCC in naïve CHB patients aged ≥ 40 years in an endemic area is of benefit.

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Section: Discussionsupporting

confidence: 86%

Hepatocellular carcinoma screening and surveillance in 2293 chronic hepatitis B patients in an endemic area

Ungtrakul¹,

Mahidol²,

Chun-on³

et al. 2016

WJG

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“…This CUA study indicates that DTP-HepB-Hib vaccine offers a good value for money compared with existing EPI vaccine (DTP-HepB) at current market price. The ICER lies far below the Thailand’s standard ceiling threshold of THB 160,000 ($4,878) per QALY gained ( 16 , 17 ). The break-even analysis also shows that the vaccination program would be cost-saving if the current vaccine price is reduced by one-thirds at THB 101 ($3.1) per dose where vaccination cost was offset by reduced treatment costs due to fewer Hib-infected cases.…”

Section: Discussionmentioning

confidence: 91%

“…This also allows the allocative efficiency among competed health measures under a limited health care budget. It is also important to note that the cost-effectiveness ceiling threshold used in our analysis is based on the local preference of decision makers/bodies ( 16 , 17 ). Under other circumstances, they may have their own preference regarding health investment.…”

Section: Discussionmentioning

confidence: 99%

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Economic Evaluation and Budget Impact Analysis of Vaccination against Haemophilus influenzae Type b Infection in Thailand

Kotirum

Muangchana

Techathawat

et al. 2017

Front. Public Health

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Current study aimed to estimate clinical and economic outcomes of providing the Haemophilus influenzae type b (Hib) vaccination as a national vaccine immunization program in Thailand. A decision tree combined with Markov model was developed to simulate relevant costs and health outcomes covering lifetime horizon in societal and health care payer perspectives. This analysis considered children aged under 5 years old whom preventive vaccine of Hib infection are indicated. Two combined Hib vaccination schedules were considered: three-dose series (3 + 0) and three-dose series plus a booster does (3 + 1) compared with no vaccination. Budget impact analysis was also performed under Thai government perspective. The outcomes were reported as Hib-infected cases averted and incremental cost-effectiveness ratios (ICERs) in 2014 Thai baht (THB) ($) per quality-adjusted life year (QALY) gained. In base-case scenario, the model estimates that 3,960 infected cases, 59 disability cases, and 97 deaths can be prevented by national Hib vaccination program. The ICER for 3 + 0 schedule was THB 1,099 ($34) per QALY gained under societal perspective. The model was sensitive to pneumonia incidence among aged under 5 years old and direct non-medical care cost per episode of Hib pneumonia. Hib vaccination is very cost-effective in the Thai context. The budget impact analysis showed that Thai government needed to invest an additional budget of 110 ($3.4) million to implement Hib vaccination program. Policy makers should consider our findings for adopting this vaccine into national immunization program.

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“…Qi-Wen Li 1& , Hong-Bing Chen 2& , Zhi-Yang Li 1 , Peng Shen 3 , Li-Li Qu 1 , Lai-Ling Gong 1 , Hong-Pan Xu 1 , Lu Pang 1 , Jin Si 1 * detection and surgical extraction are in urgent demand (Stefaniuk et al, 2010;Masuzaki et al, 2012). At present, CT, MRI and biomarker could help establish noninvasive diagnosis, and the use of ultrasonography with or without serum alpha-fetoprotein (AFP) determination was recommended for screening and surveillance (Sangmala et al, 2014), Serum AFP is the most commonly used biomarker for HCC, but the clinical diagnostic accuracy to detect early HCC has been questioned as its sensitivity and specificity are only around 60% (Marrero et al, 2009;Lok et al, 2010). A large number of HCC patients have AFP levels below the critical value which is difficult to undergo detection and prognosis of HCC (Yamashita et al, 2008).…”

Section: Preparation and Characterization Of Anti-gp73 Monoclonal Antibodies And Development Of Double-antibody Sandwich Elisamentioning

confidence: 99%

Preparation and Characterization of Anti-GP73 Monoclonal Antibodies and Development of Double-antibody Sandwich ELISA

Li¹,

Chen²,

Li³

et al. 2015

Asian Pacific Journal of Cancer Prevention

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Background: Serum Golgi protein 73 (GP73) as a novel and potential marker for diagnosing hepatocellular carcinoma (HCC) have been found to be elevated in HCC patients and associated with clinical variables representing tumor growth and invasiveness. The aim of this study was to prepare a pair of monoclonal antibodys (mAbs) against GP73 and develop a newly designed double-antibody sandwich enzyme-linked immunosorbent assay (s-ELISA), which would be used in the detection of serum GP73 (sGP73) as well as in the diagnosis of HCC. Materials and Methods: Produced by prokaryotic expression, the purified recombinant GP73 (rGP73), produced by prokaryotic expression, was used to immunize the Balb/c mice. Two hybridoma cell lines against GP73 were obtained by fusing mouse Sp2/0 myeloma cells with spleen cells from the immunized mice. The titers of anti-GP73 mAb reached 1:243,000. Western blotting analysis and Immunohistochemistry staining revealed that anti-GP73 mAb could recognize GP73 protein. The double-antibody s-ELISA was successfully established and validated by 119 HCC and 103 normal serum samples. Results: showed that the detection limit of this method could reach 1.56 ng/ml, and sGP73 levels in HCC group (mean=190.6 ng/ml) were much higher than those of in healthy controls (mean=70.92 ng/ml). Conclusions: Results of our study not only showed that sGP73 levels of HCC patients were significantly higher than those of healthy controls, but also indicated that the laboratory homemade anti-GP73 mAbs could be the optimal tool used in evaluating sGP73 levels, which would provide a solid foundation for subsequent clinical applications.

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Economic Evaluation and Budget Impact Analysis of the Surveillance Program for Hepatocellular Carcinoma in Thai Chronic Hepatitis B Patients

Cited by 16 publications

References 67 publications

Hepatocellular carcinoma screening and surveillance in 2293 chronic hepatitis B patients in an endemic area

Hepatocellular carcinoma screening and surveillance in 2293 chronic hepatitis B patients in an endemic area

Economic Evaluation and Budget Impact Analysis of Vaccination against Haemophilus influenzae Type b Infection in Thailand

Preparation and Characterization of Anti-GP73 Monoclonal Antibodies and Development of Double-antibody Sandwich ELISA

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