| Summary: | 碩士 === 國立臺灣大學 === 公共衛生學研究所 === 81 === Hepatocellular carcinoma (HCC) is the leading cause of cancer
death in Taiwan. The disease is curable only when diagnosed at
an early stage. Screening tools such as AFP and ultrasonography
(US) have been reported to be sensitive and specific for the
early detection of HCC in high risk groups. A community-based
screening of HCC for the general population in Taiwan has thus
been proposed by many researchers. Before the implementation of
any community screening program, a thorough evaluation of its
feasibility and efficacy is needed. Randomized controlled trial
(RCT) is the optimal method to evaluate a screening program.
But due to the enormous resource and manpower required, the
applicability of RCTs is limited in the real world. Simulation
modelling, with efficiency and simplicity, is thus a good
substitute. We built a model to characterize the natural
history and clinical process of HCC for men aged 30-69 in
Taiwan, using data from both published studies and expert
opinions. Microsimulation approach was used to take the
personal characteristics and past events into consideration.
Through a "Second-level" validation, the mortality simulated by
the model fit the observed data quite well, suggesting the
computer model was appropriate to simulate the real situation.
Costs and effectiveness of different screening programs were
estimated with the validated model. The outcomes of a
hypothetical group of 86,920 men (2% of men aged 30-69 in
Taiwan) were simulated for 10 years. In this preliminary
analysis, the result showed the costs could be very high if the
screening program was lack of design. To focus on the high
risk group and to improve the validity of diagnostic tools and
effectiveness of treatment will be the key to an efficient
community-based HCC screening programs.
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