ArticleThe American journal of gastroenterology2020
Cost-Effectiveness of Hepatocellular Carcinoma Surveillance: An Assessment of Benefits and Harms.
Article in The American journal of gastroenterology, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 102 papers, 8 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
102 citing papers in PubMed, 8 syntheses or guidelines pooled it, 142 citations in OpenAlex.
- AGA Clinical Practice Update on Risk Stratification and Emerging Surveillance Strategies for Hepatocellular Carcinoma: Expert Review.Gastroenterology · 2026Guideline
- Clinical practice guidelines for hepatocellular carcinoma surveillance for people at high risk in Australia: summary of recommendations.The Medical journal of Australia · 2025Guideline
- British Society of Gastroenterology guidelines for diagnosis and management of autoimmune hepatitis.Gut · 2025Guideline
- SEOM-GEMCAD-TTD clinical guidelines for the management of hepatocarcinoma patients (2023).Clinical & translational oncology : official publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico · 2024Guideline
- Guideline
- EASL-EASD-EASO Clinical Practice Guidelines on the Management of Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD).Obesity facts · 2024Guideline
- 2022 KLCA-NCC Korea practice guidelines for the management of hepatocellular carcinoma.Clinical and molecular hepatology · 2022Guideline
- Sex and regional disparities in incidence of hepatocellular carcinoma in autoimmune hepatitis: a systematic review and meta-analysis.Hepatology international · 2021Pooled it
- Hepatocellular carcinoma surveillance may be associated with potential psychological harms in patients with cirrhosis.Hepatology (Baltimore, Md.) · 2024Trial
- Development and validation of risk stratification models for hepatocellular cancer: A framework from the translational liver cancer consortium.Hepatology (Baltimore, Md.) · 2026Review
- The Malaysian Society of Gastroenterology and Hepatology Consensus Statements on Prevention and Early Detection of Hepatocellular Carcinoma in Malaysia.Journal of gastroenterology and hepatology · 2026Review
- Optimizing hepatocellular carcinoma screening in the era of metabolic dysfunction-associated steatotic liver disease and alcohol-related liver disease: time to lower the alpha-fetoprotein threshold.Journal of gastrointestinal oncology · 2026Article
- National guideline for hepatitis B elimination in Thailand: a decentralized health system model for expanding diagnosis and treatment.Hepatology international · 2026Article
- Cost-effectiveness of HES V2.0 and GALAD for hepatocellular carcinoma surveillance in patients with cirrhosis.Hepatology communications · 2026Article
- Methylation plus alpha-fetoprotein blood test for early detection of HCC in at-risk populations.Hepatology communications · 2026Article
- Article
- Improving Hepatocellular Carcinoma Surveillance in Ambulatory Hepatology: A PDSA Quality Improvement Initiative.Nursing reports (Pavia, Italy) · 2026Article
- Costs and health outcomes of liver transplantation for hepatocellular carcinoma: a scoping review.Cost effectiveness and resource allocation : C/E · 2026Review
- Proposal for Modified Alpha Fetoprotein Use in Hepatocellular Carcinoma Surveillance: Analysis of the 2018-2020 National Cancer Screening Program.Journal of Korean medical science · 2026Article
- Comparative Evaluation of Proprietary and Open-Source Large Language Models for Systematic Multi-source Information Extraction in Interventional Oncology.Cardiovascular and interventional radiology · 2026Article
42 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
4 authors at 2 institutions in 1 country.
Funding
Abstract
introductionThe value of hepatocellular carcinoma (HCC) surveillance is defined by the balance of benefits, i.e., early tumor detection, and potential harms, related to false positive and indeterminate results. Although physical harms can be observed in 15%-20% of patients with cirrhosis undergoing HCC surveillance, previous cost-effectiveness analyses have not incorporated costs of harms. We aimed to evaluate the cost-effectiveness of HCC surveillance including both benefits and harms.
designWe constructed a Markov model to compare surveillance strategies of ultrasound (US) alone, US and alpha fetoprotein (AFP), and no surveillance in 1 million simulated patients with compensated cirrhosis. Harms included imaging and biopsy in patients undergoing surveillance for HCC. Model inputs were based on literature review, and costs were derived from the Medicare fee schedule, with all costs inflated to 2018 dollars. The primary outcome was the incremental cost-effectiveness ratio per incremental quality-adjusted life-year.
resultsIn the base case analysis, US with AFP was the dominant strategy over both US alone and no surveillance. In a probabilistic sensitivity analysis, US with AFP was the most cost-effective strategy in 80.1% of simulations at a willingness-to-pay threshold of $100,000 per quality-adjusted life-year. In our threshold analyses, an HCC incidence >0.4% per year and surveillance adherence >19.5% biannually were necessary for US with AFP to be cost-effective compared with no surveillance. DISCUSSION: Accounting for both surveillance-related benefits and harms, US and AFP is more cost-effective for HCC surveillance than US alone or no surveillance in patients with compensated cirrhosis.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.