Screening for hepatocellular carcinoma: survival benefit and cost-effectiveness.

BACKGROUND: The prognosis for patients with hepatocellular carcinoma (HCC) is poor by the time they present with symptoms. This review examines the usefulness of screening programs from the perspectives of survival benefit and of cost-effectiveness. MATERIALS AND METHODS: Articles were searched through Medline for screening, HCC, treatment and cost-effectiveness. RESULTS: Both ultrasonography and alpha-fetoprotein testing have a low sensitivity for detecting HCC, although a combination of the two investigations can increase sensitivity. They remain the main screening methods because they are convenient, non-invasive and easily assessable. Though earlier studies fail to show improvement in patient management and survival by screening, more recent studies demonstrate that screening can increase the chance of curative treatment and, more importantly, improve survival even after the adjustment of lead-time bias. This is probably due to the improvement in medical treatment and technology. The cost per tumor detected for a region is inversely proportional to the tumor incidence of that region. CONCLUSIONS: In countries with a low prevalence of HCC, screening for HCC is not cost-effective. But in countries with a high prevalence of HCC, especially when screening is directed at older patients with a high risk of HCC, screening programs for HCC become much more cost-effective.