Duration and cost-effectiveness of hepatocellular carcinoma surveillance in hepatitis C patients after viral eradication
Successful treatment of chronic hepatitis C with oral direct-acting antivirals (DAAs) leads to virological cure, however, the subsequent risk of hepatocellular carcinoma (HCC) persists. Our objective was to evaluate the cost-effectiveness of biannual surveillance for HCC in patients cured of hepatit...
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| Veröffentlicht in: | Journal of hepatology 2022-07, Vol.77 (1), p.55-62 |
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| creator | Mueller, Peter P. Chen, Qiushi Ayer, Turgay Nemutlu, Gizem S. Hajjar, Ali Bethea, Emily D. Peters, Mary Linton B. Lee, Brian P. Janjua, Naveed Z. Kanwal, Fasiha Chhatwal, Jagpreet |
| description | Successful treatment of chronic hepatitis C with oral direct-acting antivirals (DAAs) leads to virological cure, however, the subsequent risk of hepatocellular carcinoma (HCC) persists. Our objective was to evaluate the cost-effectiveness of biannual surveillance for HCC in patients cured of hepatitis C and the optimal age to stop surveillance.
We developed a microsimulation model of the natural history of HCC in individuals with hepatitis C and advanced fibrosis or cirrhosis who achieved virological cure with oral DAAs. We used published data on HCC incidence, tumor progression, real-world HCC surveillance adherence, and costs and utilities of different health states. We compared biannual HCC surveillance using ultrasound and alpha-fetoprotein for varying durations of surveillance (from 5 years to lifetime) vs. no surveillance.
In virologically cured patients with cirrhosis, the incremental cost-effectiveness ratio (ICER) of biannual surveillance remained below $150,000 per additional quality-adjusted life year (QALY) (range: $79,500-$94,800) when surveillance was stopped at age 70, irrespective of the starting age (40-65). Compared with no surveillance, surveillance detected 130 additional HCCs in ‘very early’/early stage and yielded 51 additional QALYs per 1,000 patients with cirrhosis. In virologically cured patients with advanced fibrosis, the ICER of biannual surveillance remained below $150,000/QALY (range: $124,600-$129,800) when surveillance was stopped at age 60, irrespective of the starting age (40-50). Compared with no surveillance, surveillance detected 24 additional HCCs in ‘very early’/early stage and yielded 12 additional QALYs per 1,000 patients with advanced fibrosis.
Biannual surveillance for HCC in patients cured of hepatitis C is cost-effective until the age of 70 for patients with cirrhosis, and until the age of 60 for patients with stable advanced fibrosis.
Individuals who are cured of hepatitis C using oral antiviral drugs remain at risk of developing liver cancer. The value of lifelong screening for liver cancer in these individuals is not known. By simulating the life course of hepatitis C cured individuals, we found that ultrasound-based biannual screening for liver cancer is cost-effective up to age 70 in those with cirrhosis and up to age 60 in those with stable advanced fibrosis.
[Display omitted]
•The value of lifelong surveillance for HCC in individuals after SVR is not known.•Ultrasound-based bi-annual surveillance for HCC |
| doi_str_mv | 10.1016/j.jhep.2022.01.027 |
| format | Article |
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We developed a microsimulation model of the natural history of HCC in individuals with hepatitis C and advanced fibrosis or cirrhosis who achieved virological cure with oral DAAs. We used published data on HCC incidence, tumor progression, real-world HCC surveillance adherence, and costs and utilities of different health states. We compared biannual HCC surveillance using ultrasound and alpha-fetoprotein for varying durations of surveillance (from 5 years to lifetime) vs. no surveillance.
In virologically cured patients with cirrhosis, the incremental cost-effectiveness ratio (ICER) of biannual surveillance remained below $150,000 per additional quality-adjusted life year (QALY) (range: $79,500-$94,800) when surveillance was stopped at age 70, irrespective of the starting age (40-65). Compared with no surveillance, surveillance detected 130 additional HCCs in ‘very early’/early stage and yielded 51 additional QALYs per 1,000 patients with cirrhosis. In virologically cured patients with advanced fibrosis, the ICER of biannual surveillance remained below $150,000/QALY (range: $124,600-$129,800) when surveillance was stopped at age 60, irrespective of the starting age (40-50). Compared with no surveillance, surveillance detected 24 additional HCCs in ‘very early’/early stage and yielded 12 additional QALYs per 1,000 patients with advanced fibrosis.
Biannual surveillance for HCC in patients cured of hepatitis C is cost-effective until the age of 70 for patients with cirrhosis, and until the age of 60 for patients with stable advanced fibrosis.
Individuals who are cured of hepatitis C using oral antiviral drugs remain at risk of developing liver cancer. The value of lifelong screening for liver cancer in these individuals is not known. By simulating the life course of hepatitis C cured individuals, we found that ultrasound-based biannual screening for liver cancer is cost-effective up to age 70 in those with cirrhosis and up to age 60 in those with stable advanced fibrosis.
[Display omitted]
•The value of lifelong surveillance for HCC in individuals after SVR is not known.•Ultrasound-based bi-annual surveillance for HCC appears to be cost-effective up to age 75 in those with cirrhosis.•This surveillance strategy was cost effective up to age 60 in those with stable advanced fibrosis.•Compared with no surveillance, surveillance detected 86 additional HCCs in ‘very early’/early stage per 1,000 patients with cirrhosis.</description><identifier>ISSN: 0168-8278</identifier><identifier>EISSN: 1600-0641</identifier><identifier>DOI: 10.1016/j.jhep.2022.01.027</identifier><identifier>PMID: 35157959</identifier><language>eng</language><publisher>Netherlands: Elsevier B.V</publisher><subject>Age ; Aged ; Antiviral agents ; Antiviral Agents - therapeutic use ; Carcinoma, Hepatocellular - diagnosis ; Carcinoma, Hepatocellular - epidemiology ; Carcinoma, Hepatocellular - etiology ; Cirrhosis ; Cost analysis ; Cost-Benefit Analysis ; Fibrosis ; health economics ; Hepacivirus ; Hepatitis C ; Hepatitis C - drug therapy ; Hepatitis C, Chronic - complications ; Hepatitis C, Chronic - drug therapy ; Hepatitis C, Chronic - epidemiology ; Hepatocellular carcinoma ; Humans ; Liver cancer ; Liver cirrhosis ; Liver Cirrhosis - complications ; Liver Cirrhosis - drug therapy ; Liver Cirrhosis - epidemiology ; Liver Neoplasms - diagnosis ; Liver Neoplasms - epidemiology ; Liver Neoplasms - etiology ; Middle Aged ; Patients ; screening ; simulation modeling ; Surveillance ; Tumors ; Ultrasonic imaging ; Ultrasound ; α-Fetoprotein</subject><ispartof>Journal of hepatology, 2022-07, Vol.77 (1), p.55-62</ispartof><rights>2022 European Association for the Study of the Liver</rights><rights>Copyright © 2022 European Association for the Study of the Liver. All rights reserved.</rights><rights>Copyright Elsevier Science Ltd. Jul 2022</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c483t-cf90e708cc862ee50f1b6222760560b95922bcf69c45798507f23280bd4253153</citedby><cites>FETCH-LOGICAL-c483t-cf90e708cc862ee50f1b6222760560b95922bcf69c45798507f23280bd4253153</cites><orcidid>0000-0003-4654-9798 ; 0000-0001-8741-4430 ; 0000-0003-0905-7583 ; 0000-0003-2108-1287 ; 0000-0002-3658-375X ; 0000-0002-5334-0362 ; 0000-0003-4031-2669</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0168827822000745$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,776,780,881,3537,27901,27902,65534</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35157959$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Mueller, Peter P.</creatorcontrib><creatorcontrib>Chen, Qiushi</creatorcontrib><creatorcontrib>Ayer, Turgay</creatorcontrib><creatorcontrib>Nemutlu, Gizem S.</creatorcontrib><creatorcontrib>Hajjar, Ali</creatorcontrib><creatorcontrib>Bethea, Emily D.</creatorcontrib><creatorcontrib>Peters, Mary Linton B.</creatorcontrib><creatorcontrib>Lee, Brian P.</creatorcontrib><creatorcontrib>Janjua, Naveed Z.</creatorcontrib><creatorcontrib>Kanwal, Fasiha</creatorcontrib><creatorcontrib>Chhatwal, Jagpreet</creatorcontrib><title>Duration and cost-effectiveness of hepatocellular carcinoma surveillance in hepatitis C patients after viral eradication</title><title>Journal of hepatology</title><addtitle>J Hepatol</addtitle><description>Successful treatment of chronic hepatitis C with oral direct-acting antivirals (DAAs) leads to virological cure, however, the subsequent risk of hepatocellular carcinoma (HCC) persists. Our objective was to evaluate the cost-effectiveness of biannual surveillance for HCC in patients cured of hepatitis C and the optimal age to stop surveillance.
We developed a microsimulation model of the natural history of HCC in individuals with hepatitis C and advanced fibrosis or cirrhosis who achieved virological cure with oral DAAs. We used published data on HCC incidence, tumor progression, real-world HCC surveillance adherence, and costs and utilities of different health states. We compared biannual HCC surveillance using ultrasound and alpha-fetoprotein for varying durations of surveillance (from 5 years to lifetime) vs. no surveillance.
In virologically cured patients with cirrhosis, the incremental cost-effectiveness ratio (ICER) of biannual surveillance remained below $150,000 per additional quality-adjusted life year (QALY) (range: $79,500-$94,800) when surveillance was stopped at age 70, irrespective of the starting age (40-65). Compared with no surveillance, surveillance detected 130 additional HCCs in ‘very early’/early stage and yielded 51 additional QALYs per 1,000 patients with cirrhosis. In virologically cured patients with advanced fibrosis, the ICER of biannual surveillance remained below $150,000/QALY (range: $124,600-$129,800) when surveillance was stopped at age 60, irrespective of the starting age (40-50). Compared with no surveillance, surveillance detected 24 additional HCCs in ‘very early’/early stage and yielded 12 additional QALYs per 1,000 patients with advanced fibrosis.
Biannual surveillance for HCC in patients cured of hepatitis C is cost-effective until the age of 70 for patients with cirrhosis, and until the age of 60 for patients with stable advanced fibrosis.
Individuals who are cured of hepatitis C using oral antiviral drugs remain at risk of developing liver cancer. The value of lifelong screening for liver cancer in these individuals is not known. By simulating the life course of hepatitis C cured individuals, we found that ultrasound-based biannual screening for liver cancer is cost-effective up to age 70 in those with cirrhosis and up to age 60 in those with stable advanced fibrosis.
[Display omitted]
•The value of lifelong surveillance for HCC in individuals after SVR is not known.•Ultrasound-based bi-annual surveillance for HCC appears to be cost-effective up to age 75 in those with cirrhosis.•This surveillance strategy was cost effective up to age 60 in those with stable advanced fibrosis.•Compared with no surveillance, surveillance detected 86 additional HCCs in ‘very early’/early stage per 1,000 patients with cirrhosis.</description><subject>Age</subject><subject>Aged</subject><subject>Antiviral agents</subject><subject>Antiviral Agents - therapeutic use</subject><subject>Carcinoma, Hepatocellular - diagnosis</subject><subject>Carcinoma, Hepatocellular - epidemiology</subject><subject>Carcinoma, Hepatocellular - etiology</subject><subject>Cirrhosis</subject><subject>Cost analysis</subject><subject>Cost-Benefit Analysis</subject><subject>Fibrosis</subject><subject>health economics</subject><subject>Hepacivirus</subject><subject>Hepatitis C</subject><subject>Hepatitis C - drug therapy</subject><subject>Hepatitis C, Chronic - complications</subject><subject>Hepatitis C, Chronic - drug therapy</subject><subject>Hepatitis C, Chronic - epidemiology</subject><subject>Hepatocellular carcinoma</subject><subject>Humans</subject><subject>Liver cancer</subject><subject>Liver cirrhosis</subject><subject>Liver Cirrhosis - complications</subject><subject>Liver Cirrhosis - drug therapy</subject><subject>Liver Cirrhosis - epidemiology</subject><subject>Liver Neoplasms - diagnosis</subject><subject>Liver Neoplasms - epidemiology</subject><subject>Liver Neoplasms - etiology</subject><subject>Middle Aged</subject><subject>Patients</subject><subject>screening</subject><subject>simulation modeling</subject><subject>Surveillance</subject><subject>Tumors</subject><subject>Ultrasonic imaging</subject><subject>Ultrasound</subject><subject>α-Fetoprotein</subject><issn>0168-8278</issn><issn>1600-0641</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kU-L1TAUxYMozpunX8CFBNy4ab1JmzYFEYbn-AcG3Og6pOmNk9KXPJO26Lc39Y2DunCVQM49Oef-CHnGoGTAmldjOd7iqeTAeQmsBN4-IDvWABTQ1Owh2WWRLCRv5QW5TGkEgAq6-jG5qAQTbSe6Hfn-dol6dsFT7QdqQpoLtBbN7Fb0mBINluZP9BwMTtMy6UiNjsb5cNQ0LXFFN03aG6TOn4Vudoke6HZDPyeq7YyRri7qiWLUgzO__ntCHlk9JXx6d-7Jl3fXnw8fiptP7z8erm4KU8tqLoztAFuQxsiGIwqwrG84520DooE-d-C8N7bpTJ0bSQGt5RWX0A81FxUT1Z68Ofuelv6Ig8mZchJ1iu6o4w8VtFN_v3h3q76GVXUNk5XossHLO4MYvi2YZnV0aVuG9hiWpHjDOxBtJessffGPdAxL9Lme4m2OU_MqI9gTflaZGFKKaO_DMFAbWDWqDazawCpgKoPNQ8__rHE_8ptkFrw-CzAvc3UYVTIZgMHBxYxTDcH9z_8nIFi2Xg</recordid><startdate>20220701</startdate><enddate>20220701</enddate><creator>Mueller, Peter P.</creator><creator>Chen, Qiushi</creator><creator>Ayer, Turgay</creator><creator>Nemutlu, Gizem S.</creator><creator>Hajjar, Ali</creator><creator>Bethea, Emily D.</creator><creator>Peters, Mary Linton B.</creator><creator>Lee, Brian P.</creator><creator>Janjua, Naveed Z.</creator><creator>Kanwal, Fasiha</creator><creator>Chhatwal, Jagpreet</creator><general>Elsevier B.V</general><general>Elsevier Science Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>H94</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0003-4654-9798</orcidid><orcidid>https://orcid.org/0000-0001-8741-4430</orcidid><orcidid>https://orcid.org/0000-0003-0905-7583</orcidid><orcidid>https://orcid.org/0000-0003-2108-1287</orcidid><orcidid>https://orcid.org/0000-0002-3658-375X</orcidid><orcidid>https://orcid.org/0000-0002-5334-0362</orcidid><orcidid>https://orcid.org/0000-0003-4031-2669</orcidid></search><sort><creationdate>20220701</creationdate><title>Duration and cost-effectiveness of hepatocellular carcinoma surveillance in hepatitis C patients after viral eradication</title><author>Mueller, Peter P. ; Chen, Qiushi ; Ayer, Turgay ; Nemutlu, Gizem S. ; Hajjar, Ali ; Bethea, Emily D. ; Peters, Mary Linton B. ; Lee, Brian P. ; Janjua, Naveed Z. ; Kanwal, Fasiha ; Chhatwal, Jagpreet</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c483t-cf90e708cc862ee50f1b6222760560b95922bcf69c45798507f23280bd4253153</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Age</topic><topic>Aged</topic><topic>Antiviral agents</topic><topic>Antiviral Agents - therapeutic use</topic><topic>Carcinoma, Hepatocellular - diagnosis</topic><topic>Carcinoma, Hepatocellular - epidemiology</topic><topic>Carcinoma, Hepatocellular - etiology</topic><topic>Cirrhosis</topic><topic>Cost analysis</topic><topic>Cost-Benefit Analysis</topic><topic>Fibrosis</topic><topic>health economics</topic><topic>Hepacivirus</topic><topic>Hepatitis C</topic><topic>Hepatitis C - drug therapy</topic><topic>Hepatitis C, Chronic - complications</topic><topic>Hepatitis C, Chronic - drug therapy</topic><topic>Hepatitis C, Chronic - epidemiology</topic><topic>Hepatocellular carcinoma</topic><topic>Humans</topic><topic>Liver cancer</topic><topic>Liver cirrhosis</topic><topic>Liver Cirrhosis - complications</topic><topic>Liver Cirrhosis - drug therapy</topic><topic>Liver Cirrhosis - epidemiology</topic><topic>Liver Neoplasms - diagnosis</topic><topic>Liver Neoplasms - epidemiology</topic><topic>Liver Neoplasms - etiology</topic><topic>Middle Aged</topic><topic>Patients</topic><topic>screening</topic><topic>simulation modeling</topic><topic>Surveillance</topic><topic>Tumors</topic><topic>Ultrasonic imaging</topic><topic>Ultrasound</topic><topic>α-Fetoprotein</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Mueller, Peter P.</creatorcontrib><creatorcontrib>Chen, Qiushi</creatorcontrib><creatorcontrib>Ayer, Turgay</creatorcontrib><creatorcontrib>Nemutlu, Gizem S.</creatorcontrib><creatorcontrib>Hajjar, Ali</creatorcontrib><creatorcontrib>Bethea, Emily D.</creatorcontrib><creatorcontrib>Peters, Mary Linton B.</creatorcontrib><creatorcontrib>Lee, Brian P.</creatorcontrib><creatorcontrib>Janjua, Naveed Z.</creatorcontrib><creatorcontrib>Kanwal, Fasiha</creatorcontrib><creatorcontrib>Chhatwal, Jagpreet</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of hepatology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Mueller, Peter P.</au><au>Chen, Qiushi</au><au>Ayer, Turgay</au><au>Nemutlu, Gizem S.</au><au>Hajjar, Ali</au><au>Bethea, Emily D.</au><au>Peters, Mary Linton B.</au><au>Lee, Brian P.</au><au>Janjua, Naveed Z.</au><au>Kanwal, Fasiha</au><au>Chhatwal, Jagpreet</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Duration and cost-effectiveness of hepatocellular carcinoma surveillance in hepatitis C patients after viral eradication</atitle><jtitle>Journal of hepatology</jtitle><addtitle>J Hepatol</addtitle><date>2022-07-01</date><risdate>2022</risdate><volume>77</volume><issue>1</issue><spage>55</spage><epage>62</epage><pages>55-62</pages><issn>0168-8278</issn><eissn>1600-0641</eissn><abstract>Successful treatment of chronic hepatitis C with oral direct-acting antivirals (DAAs) leads to virological cure, however, the subsequent risk of hepatocellular carcinoma (HCC) persists. Our objective was to evaluate the cost-effectiveness of biannual surveillance for HCC in patients cured of hepatitis C and the optimal age to stop surveillance.
We developed a microsimulation model of the natural history of HCC in individuals with hepatitis C and advanced fibrosis or cirrhosis who achieved virological cure with oral DAAs. We used published data on HCC incidence, tumor progression, real-world HCC surveillance adherence, and costs and utilities of different health states. We compared biannual HCC surveillance using ultrasound and alpha-fetoprotein for varying durations of surveillance (from 5 years to lifetime) vs. no surveillance.
In virologically cured patients with cirrhosis, the incremental cost-effectiveness ratio (ICER) of biannual surveillance remained below $150,000 per additional quality-adjusted life year (QALY) (range: $79,500-$94,800) when surveillance was stopped at age 70, irrespective of the starting age (40-65). Compared with no surveillance, surveillance detected 130 additional HCCs in ‘very early’/early stage and yielded 51 additional QALYs per 1,000 patients with cirrhosis. In virologically cured patients with advanced fibrosis, the ICER of biannual surveillance remained below $150,000/QALY (range: $124,600-$129,800) when surveillance was stopped at age 60, irrespective of the starting age (40-50). Compared with no surveillance, surveillance detected 24 additional HCCs in ‘very early’/early stage and yielded 12 additional QALYs per 1,000 patients with advanced fibrosis.
Biannual surveillance for HCC in patients cured of hepatitis C is cost-effective until the age of 70 for patients with cirrhosis, and until the age of 60 for patients with stable advanced fibrosis.
Individuals who are cured of hepatitis C using oral antiviral drugs remain at risk of developing liver cancer. The value of lifelong screening for liver cancer in these individuals is not known. By simulating the life course of hepatitis C cured individuals, we found that ultrasound-based biannual screening for liver cancer is cost-effective up to age 70 in those with cirrhosis and up to age 60 in those with stable advanced fibrosis.
[Display omitted]
•The value of lifelong surveillance for HCC in individuals after SVR is not known.•Ultrasound-based bi-annual surveillance for HCC appears to be cost-effective up to age 75 in those with cirrhosis.•This surveillance strategy was cost effective up to age 60 in those with stable advanced fibrosis.•Compared with no surveillance, surveillance detected 86 additional HCCs in ‘very early’/early stage per 1,000 patients with cirrhosis.</abstract><cop>Netherlands</cop><pub>Elsevier B.V</pub><pmid>35157959</pmid><doi>10.1016/j.jhep.2022.01.027</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0003-4654-9798</orcidid><orcidid>https://orcid.org/0000-0001-8741-4430</orcidid><orcidid>https://orcid.org/0000-0003-0905-7583</orcidid><orcidid>https://orcid.org/0000-0003-2108-1287</orcidid><orcidid>https://orcid.org/0000-0002-3658-375X</orcidid><orcidid>https://orcid.org/0000-0002-5334-0362</orcidid><orcidid>https://orcid.org/0000-0003-4031-2669</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | Journal of hepatology, 2022-07, Vol.77 (1), p.55-62 |
| issn | 0168-8278 1600-0641 |
| language | eng |
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| source | MEDLINE; Elsevier ScienceDirect Journals Complete |
| subjects | Age Aged Antiviral agents Antiviral Agents - therapeutic use Carcinoma, Hepatocellular - diagnosis Carcinoma, Hepatocellular - epidemiology Carcinoma, Hepatocellular - etiology Cirrhosis Cost analysis Cost-Benefit Analysis Fibrosis health economics Hepacivirus Hepatitis C Hepatitis C - drug therapy Hepatitis C, Chronic - complications Hepatitis C, Chronic - drug therapy Hepatitis C, Chronic - epidemiology Hepatocellular carcinoma Humans Liver cancer Liver cirrhosis Liver Cirrhosis - complications Liver Cirrhosis - drug therapy Liver Cirrhosis - epidemiology Liver Neoplasms - diagnosis Liver Neoplasms - epidemiology Liver Neoplasms - etiology Middle Aged Patients screening simulation modeling Surveillance Tumors Ultrasonic imaging Ultrasound α-Fetoprotein |
| title | Duration and cost-effectiveness of hepatocellular carcinoma surveillance in hepatitis C patients after viral eradication |
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