Cancer Screening for Cirrhosis Patients Not Cost Effective

Cancer screening for patients with alcoholic liver damage may not be a cost effective procedure due to the low incidence of hepatocellular carcinoma deaths in this patient population, researchers found.

In the U.S., it is recommended that patients with liver cirrhosis be screened regularly for cancer, usually by ultrasound. Since false positives are a possibility, follow-up tests, some of which can be invasive or using CT scan, may be necessary. However, it is not known if the testing is cost effective in detecting and treating hepatocellular carcinoma (HCC) among patients with alcoholic liver cirrhosis.

To address this issue, researchers in Denmark studied all Danish citizens who were hospitalized for the first time with a diagnosis of alcoholic cirrhosis from 1993 to 2005. The researchers were evaluating the patients’ risk for developing and dying of liver cancer within five years of their initial cirrhosis diagnosis.

Of the 8,482 patients in the study, published this week in the Annals of Internal Medicine, 169 developed HCC. Of the original group, 5,737 died, but only 151 had developed HCC.
The researchers reported that the five-year cumulative risk for HCC was 1.0 percent and five-year mortality was 43.7 percent. According to the study, only 1.8 percent of the deaths were related to the liver cancer.

The researchers concluded that the patients in this study group did not have a higher mortality rate than patients in the nationwide cohort. “Danish patients with alcoholic cirrhosis have a low risk for HCC, and HCC contributes little to their high mortality,” the authors wrote. “On the basis of these data, HCC surveillance would be expected to have a minimal effect on mortality and is unlikely to be cost effective.”

There have been other studies examining this issue, but according to Dr. Peter Jepsen of Aarhus University Hospital, the clinic-based studies looked at select patients who were already being treated, while this population-based study looked at the patients who were newly diagnosed with alcoholic cirrhosis of the liver.