12 April 2018, Paris, France: Surveillance for hepatocellular carcinoma (HCC) by ultrasound is likely to be cost effective in patients with hepatitis C-related liver cirrhosis after they have achieved a sustained virological response (SVR) to direct-acting antiviral agents (DAAs), according to the results of a Canadian study presented today. The study also found that screening is very unlikely to be cost effective in patients with advanced liver fibrosis but without evidence of cirrhosis (e.g. METAVIR stage F3), challenging current clinical practice guidelines.
Hepatitis C virus (HCV) infection is a major cause of HCC worldwide, and although the HCC risk is reduced substantially after SVR, it is not eliminated entirely.1 Surveillance for HCC among people with HCV infection is considered to be cost effective if the risk of HCC exceeds 1.5% per year prior to SVR; however, after achieving SVR, the values may differ because the risk of liver failure is substantially reduced. 1,10 Current HCV management guidelines recommend biannual surveillance for HCC for an indefinite period in all patients with stage 3 fibrosis or liver cirrhosis post-SVR.11,12
The study presented today at The International Liver Congress™ 2018 in Paris, France, evaluated the cost effectiveness of biannual or annual ultrasound screening for HCC
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