ArticlePloS one2026
Surveillance of hepatocellular carcinoma (HCC) patients using Protein Induced by Vitamin K (PIVKA-II): A cost-utility analysis for Hong Kong.
Article in PloS one, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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6 authors.
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Abstract
BACKGROUND &
aimsHepatocellular carcinoma (HCC) is a leading cause of cancer-related death in Hong Kong. Common risk factors include chronic hepatitis B (CHB) infection and/ or liver cirrhosis (LC). Routine HCC surveillance using ultrasound plus alpha-fetoprotein (AFP) for patients with these conditions is recommended, but many patients still face limited access to ultrasound. For these, biomarker-based surveillance using a combination of protein induced by vitamin K absence or antagonist-II (PIVKA-II) plus AFP could provide a valuable alternative.
methodsThis study compared the cost-utility of routine HCC surveillance using 'PIVKA-II + AFP' to the recommended standard-of-care in Hong Kong: surveillance using 'US + AFP'. A health economic model using a Markov-microsimulation framework was adapted using published local data and settings. The model was used to compare diagnostic outcomes, overall costs, quality-adjusted life years (QALYs), and cost-utility of the alternative HCC surveillance methods.
resultsCompared to the current recommended standard-of-care, the results suggested that HCC surveillance using 'PIVKA-II + AFP' could improve detection of HCC during early-stage disease by 4.6 percentage points, thus enabling access to more effective treatment options for some patients. It could also reduce false positive diagnoses by 7.2%, which could alleviate the need for costly confirmatory testing. Overall, PIVKA-II + AFP' was associated with a gain of 0.019 QALYs and cost savings of HK $ 4,144 per individual. The results were particularly favorable for non-cirrhotic CHB patients.
conclusionsHCC surveillance using 'PIVKA-II + AFP' could be a feasible option for patients with CHB and/ or LC who face limited access to ultrasound-based surveillance. The combination has the potential to improve early-stage HCC detection, facilitating timely intervention and improving both survival outcomes and patient quality of life.
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