Model supports liver cancer screening at lower risk in alcohol-associated cirrhosis

A mathematical model incorporating real-world screening data and clinical practices found that routine liver cancer surveillance could be cost-effective and life-extending for people with alcohol-associated cirrhosis whose estimated annual risk of hepatocellular carcinoma was as low as 0.45%. The modeled threshold was less than half the 1% annual risk used in current screening recommendations. Investigators at Mass General Brigham reported favorable results for both people who continued drinking and those who had achieved abstinence, with the study published in Clinical Gastroenterology and Hepatology.

Alcohol-associated cirrhosis is a late stage of liver disease caused by heavy drinking, in which scar tissue replaces healthy tissue and impairs liver function. The condition increases the risk of hepatocellular carcinoma, or HCC, a common form of liver cancer. Routine HCC screening can involve an ultrasound and a blood test, but current guidelines recommend it only for individuals whose annual cancer risk is above 1%. That cutoff comes from older studies, mostly involving people with viral hepatitis. More recent data indicate that annual liver cancer risk in alcohol-associated cirrhosis is often below 1%, leaving it unclear whether routine surveillance should extend to people whose risk falls below the existing threshold.

For the analysis, senior author Jagpreet Chhatwal and colleagues used a mathematical model to simulate the trajectory of liver disease in 50 million hypothetical U.S. patients with alcohol-associated cirrhosis. The model incorporated real-world screening data and clinical practices, while health outcomes were measured in quality-adjusted life years, which the investigators described as a standard measure for health economics. Rather than testing screening in a prospective clinical trial, the study compared surveillance at different estimated annual HCC risk levels to determine whether the established 1% benchmark remained beneficial and cost-effective for this population.

The model estimated that biannual screening produced 2,083 additional life-years per 100,000 modeled patients who continued drinking and 3,357 additional life-years per 100,000 abstinent patients. Screening remained cost-effective at an annual HCC risk as low as 0.45%, below the level at which current guidance generally recommends surveillance. The estimated benefit was therefore present in both groups, suggesting that decisions about screening should not depend on drinking status alone. The authors attributed the modeled gains to detecting cancer earlier, which gave patients access to treatments that can extend their lives when the disease is identified at a more treatable stage.

Chhatwal said the study indicates that the 1% benchmark used for this population is out of date and that screening with current tests and treatments provides good value at a much lower estimated risk. The findings support updating the evidence base used to define screening eligibility so that more cancers might be detected earlier while healthcare resources are used efficiently. As a modeling study, however, the research produced estimates rather than direct evidence from a randomized trial. Its conclusions therefore depend on the real-world information used to build the model. The paper, “Optimal Incidence Threshold for Cost-Effective Hepatocellular Carcinoma Surveillance in Alcohol-Associated Cirrhosis,” was funded by the National Institutes of Health and the Cancer Prevention and Research Institute of Texas.

Subject of Research: Modeled cost-effectiveness of liver cancer surveillance in alcohol-associated cirrhosis

Article Title: More people with alcohol-associated liver disease could benefit from routine liver cancer screening than current guidelines assume

Article References: More people with alcohol-associated liver disease could benefit from routine liver cancer screening than current guidelines assume. Original publication (Bibliographic details unavailable.)

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Keywords: alcohol-associated cirrhosis, hepatocellular carcinoma, liver cancer screening, surveillance, cost-effectiveness, health modeling, quality-adjusted life years, screening thresholds, people, alcohol-associated, liver, disease