Hepatocellular Carcinoma Surveillance Among Cirrhotic Patients With Commercial Health Insurance

Goldberg, David S.; Valderrama, Adriana; Kamalakar, Rajesh; Sansgiry, Sujit S.; Babajanyan, Svetlana; Lewis, James D.

doi:10.1097/mcg.0000000000000411

Cited by 40 publications

(51 citation statements)

References 35 publications

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“…Although one-third of patients underwent HCC surveillance at least once during the 2-year study period, fewer than 2% underwent consistent guideline-concordant HCC surveillance. These data are consistent with another recent report from a commercial health insurance database, in which the mean and median proportion of time up-to-date with surveillance was only 0.34 and 0.31, respectively (11). …”

Section: Discussionsupporting

confidence: 92%

Hepatocellular Carcinoma Surveillance Among Patients With Cirrhosis in a Population-based Integrated Health Care Delivery System

Singal

Tiro

et al. 2017

Journal of Clinical Gastroenterology

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Purpose Fewer than 1 in 5 patients with cirrhosis receive hepatocellular carcinoma (HCC) surveillance; however, most studies were performed in select patient populations, which may not be informative of practice patterns in population-based community practices. Further, few reported guideline-concordant consistent surveillance rates. Goals Characterize guideline-concordant HCC surveillance rates and patient-level factors associated with surveillance among a population-based cohort of patients with cirrhosis. Study We retrospectively characterized HCC surveillance among cirrhosis patients followed between January 2010 and December 2012 at an integrated healthcare delivery system in Washington state. Consistent surveillance was defined as an ultrasound every 6 months, and inconsistent surveillance was defined as ≥1 ultrasound during the two-year follow-up period. Univariate and multivariate analyses were conducted to identify correlates of HCC surveillance receipt. Results Of 1137 patients with cirrhosis, 22 (2%) underwent consistent surveillance, 371 (33%) had inconsistent surveillance, and 744 (65%) received no surveillance during follow-up. Correlates of HCC surveillance receipt in multivariate analysis included Gastroenterology/Hepatology subspecialty care (OR 1.88, 95%CI 1.44 – 2.46), Child Pugh B/C cirrhosis (OR 1.61, 95%CI 1.07 – 2.43), elevated AST (OR 1.63, 95%CI 1.13 – 2.35), and etiology of liver disease. Compared to hepatitis C-infected patients, patients with hepatitis B infection were more likely to undergo surveillance ((OR 2.72, 95%CI 1.28 – 5.81), while patients with alcohol-related cirrhosis (OR 0.63, 95%CI 0.42 – 0.93) and nonalcoholic steatohepatitis (OR 0.39, 95%CI 0.28 – 0.56) were less likely to undergo surveillance. Conclusions Although one-third of patients undergo inconsistent HCC surveillance, less than 2% of patients receive guideline-concordant biannual HCC surveillance.

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Section: Discussionsupporting

confidence: 92%

Hepatocellular Carcinoma Surveillance Among Patients With Cirrhosis in a Population-based Integrated Health Care Delivery System

Singal

Tiro

et al. 2017

Journal of Clinical Gastroenterology

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“…For this purpose, ultrasound surveillance every 6 months is recommended by the international guidelines. Goldeberg et al [52] analyzed the database from a US commercial health insurance. Among 8,916 cirrhotic patients followed during a median of 22.9 months, only 8.8% had a complete surveillance, in 55.4% it was incomplete (ultrasound assessments missing) and 35.8% had no surveillance at all.…”

Section: Hepatocellular Carcinoma: No Big News But Continuous Improvementioning

confidence: 99%

Clinical trial watch: Reports from the AASLD Liver Meeting®, Boston, November 2014

Londoño

Abraldes

Altamirano

et al. 2015

Journal of Hepatology

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The late and fast developments in the field of viral hepatitis were highly expected in the 2014 AASLD Liver Meeting®. Several combinations using direct acting antivirals (DAAs) showed high rates of sustained virological response (∼95%). Importantly, high cure rates were also demonstrated in patients with previous treatment failures, decompensated cirrhosis and hepatitis C recurrence after transplantation, making it clear that the interferon era is over (not so clear for ribavirin, which might still have a role in difficult-to-treat populations). Importantly, sustained virological response was associated with an improvement in liver function (MELD and Child-Pugh scores) in patients with advanced liver disease. In the field of liver cirrhosis, there were relevant data assessing the optimal empirical antibiotic therapy in patients with spontaneous bacterial peritonitis and high risk of resistant bacteria, as well as studies evaluating the role of terlipressin in type I hepatorenal syndrome and in septic shock. Regarding hepatic encephalopathy, two randomized trials suggest that the manipulation of the microbioma in patients with cirrhosis may have a role in the management of this complication. Some novel data on NASH support the beneficial effect of bariatric surgery (after failure of lifestyle intervention) in morbid obese patients with such diagnosis: clinical and histological improvements after surgery were evident in most patients with sufficient follow-up. A few controlled studies focused on the treatment of severe acute alcoholic hepatitis. Finally, several studies on hepatocellular carcinoma (HCC) were presented, covering topics such as ultrasound screening in cirrhosis, cryoablation treatment of early HCC and the relevance of downstaging in patients with HCC awaiting liver transplantation.

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“…Markov modeling suggests that to achieve outcome improvements in HCC, at least 34% of individuals within a cirrhosis population must undergo surveillance to yield an early‐stage diagnosis rate of at least 42% . However, reported HCC surveillance rates in most observational studies in the United States and Europe do not reach this threshold …”

mentioning

confidence: 99%

Identifying barriers to hepatocellular carcinoma surveillance in a national sample of patients with cirrhosis

et al. 2016

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Hepatocellular Carcinoma Surveillance Among Cirrhotic Patients With Commercial Health Insurance

Abstract: HCC surveillance rates in commercially insured at-risk patients remain poor despite formalized guidelines, highlighting the need to develop interventions to improve surveillance rates.

Cited by 40 publications

References 35 publications

Hepatocellular Carcinoma Surveillance Among Patients With Cirrhosis in a Population-based Integrated Health Care Delivery System

Hepatocellular Carcinoma Surveillance Among Patients With Cirrhosis in a Population-based Integrated Health Care Delivery System

Clinical trial watch: Reports from the AASLD Liver Meeting®, Boston, November 2014

Identifying barriers to hepatocellular carcinoma surveillance in a national sample of patients with cirrhosis

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