Strategic International Session (Symposium)2(JSH・JSGE・JSGS・JSGCS)
Fri. November 6th   14:00 - 17:00   Room 9: Portopia Hotel Main Building Kairaku 3
ST-S2-1_H
 Enhancing Value in HCC Surveillance: A Call for Precision Medicine
Ray Kim
Stanford University School of Medicine
Surveillance for hepatocellular carcinoma (HCC) is a value decision based on health economics rather than a medical decision, as there is little harm to surveillance testing. Value of HCC surveillance is determined by costs and outcomes altered by instituting surveillance. Ultimately, the metric by which the decision is made the incremental cost-effectiveness. Figure 1 represents the source of the recommended incidence threshold of 1.5% to recommend surveillance, as HCC incidence > 1.5% was associated with a cost-effectiveness ratio of $50,000 per quality-adjusted life year.
The current guidelines for HCC surveillance rely on crude parameters such as age and sex. To the degree that the incidence of HCC is one of the most important determinants of the effectiveness of HCC surveillance, an individualized prediction model may be more informative and able to identify surveillance candidates that may not be covered by the current guidelines. We developed the ‘ADRESS-HCC’ to predict HCC incidence, based on Age, Diabetes, Race, Etiology, Sex and Severity (Figure 2), which a score of 88 corresponds to an incidence of 1.5% per year.
Another factor that may influence the effectiveness of surveillance is the condition of the underlying cirrhosis. In patients with progressive liver disease (e.g., NASH cirrhosis), reduced HCC mortality from effective surveillance may unexpectedly increase deaths from liver failure, whereas in patients with stable cirrhosis (e.g., hepatitis C cirrhosis after sustained virological response), reduction in HCC mortality may translate closely to overall survival benefit. (Figure 3)
In summary (Figure 4), currently HCC surveillance recommendations are driven by value decisions based on limited data. By taking into account individual patient characteristics to predict their risk of HCC, surveillance may be made more efficient and cost-effective.
Index Term 1: Hepatocellular carcinoma
Index Term 2: Cost-effectiveness
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