Cost-effectiveness of Screening of Hepatocellular Carcinoma under the Condition of Interferon Therapy for the Patients of Hepatitis C Virus Infection

通过这项研究经费，我们可以获得以下结果。肝细胞癌（HCC）定期筛查试验的效果：通过对HCC患者门诊就诊模式的规律性进行回顾性调查，定期就诊的患者所检出的HCC大小明显小于不定期就诊的患者。Cox-proportional hazard analysis的结果显示，肿瘤直径小于20mm的患者生存率明显优于肿瘤直径大于20mm的患者。接受干扰素治疗的患者HCC定期筛查试验的成本-效果：我们将C型肝炎的自然病史与定期筛查和干扰素治疗的效果相结合，建立Markov模型。对典型慢性肝炎初始状态队列的模型模拟结果显示，定期筛查试验与不筛查试验的边际成本-效果比，如果定期筛查能检测出直径小于20mm的HCC，即使患者接受干扰素治疗慢性肝炎，其成本-效果比也在国际共识范围内。HCC住院费用估算：对HCC住院患者住院费用进行回顾性调查并进行统计分析。通过多变量分析，建立了一个由多个医疗干预变量组成的模型；手术切除、化疗-脂醇治疗及母体注射抗癌药物及并发症；住院期间出现腹水、水肿、静脉曲张出血。对验证数据集进行了高相关系数的住院费用预测。本研究表明，该模型由几种特定的医疗干预措施对应于每种并发症或治疗，可以适当地估计住院患者的成本4。评估干预不同HCC阶段的成本-效果模型：我们创建了一个状态转换马尔可夫模型，该模型代表了慢性肝炎、肝硬化和失代偿性肝硬化伴或不伴HCC的主要健康状态。我们假设治疗选择符合HCC的状态特征，如最大大小，数量和位置，治疗将从切除或局部消融开始，包括PEI和RFA，随着HCC的进展，局部消融加经动脉化疗栓塞（TACE）， TACE，肝动脉灌注化疗（HAIC）和保守治疗。当它被用于评估孤立性小肝癌治疗的成本效益时，预测生存率与我们机构的样本人群和日本全国调查的结果一致。少

We could obtain the following results by this research grant.1.The effect of periodic screening test for hepatocellular carcinoma (HCC) : After conducting the retrospective survey of the regularity in pattern of outpatients visits for the HCC patients, the size of HCC detected in the patients with the regular office visit significantly smaller than those with irregular office visit. The results from the Cox-proportional hazard analysis showed the survival of the patients with tumor less than 20mm in diameter would be better significantly than those with tumor more than 20mm.2.Cost-effectiveness of periodic screening test for HCC in patients received interferon therapy : we made the Markov model combined the natural history of type C hepatitis and the effect of the periodic screening and interferon therapy. The result of model simulation for typical cohort with initially chronic hepatitis state revealed the marginal cost-effectiveness ratio of the periodic screening test versus non-scre … More ening would fall in the range of international consensus even the patients received the interferon therapy for chronic hepatitis if the periodic screening could detect the HCC less than 20mm in its diameter.3.The estimation of inpatient cost for HCC : The inpatients cost of patients hospitalized due to HCC was surveyed retrospectively and analyzed statistically. As a result of multivariate analysis, a model consisted of several variables of medical intervention ; resection, chemo-lipiodol therapy and parental anticancer agent injection, and complication ; ascites and edema, and variceal bleeding in addition to the period of hospitalization was obtained. It predicted inpatient cost with the high correlation coefficient for the validation dataset. This study suggested that the model consisted of several specific medical interventions corresponding to each complication or treatment could estimate the inpatients cost appropriately4.Evaluation of a cost-effectiveness model for the interventions to the different HCC stage : we created a state-transition Markov model which represented the principal health states of chronic hepatitis, cirrhosis, and decompensated cirrhosis with or without HCC. We assumed that the treatment choice corresponded to HCC state features such as maximal size, number and location, that treatment would start with resection or local ablation, including PEI and RFA, and that, as HCC progressed, local ablation plus transarterial chemoembolization (TACE), TACE, hepatic arterial infusion chemotherapy (HAIC) and conservative treatment would be applied. When it was applied for the evaluation of the cost-effectiveness of the treatments for solitary small HCC, the predicted survival rate was consistent with those of a sample population at our institution and of a nationwide survey of Japan. Less