Cost-Effectiveness Analysis of Community Hepatocellular Carcinoma Screening-Using Computer Simulation Models

• Main Authors: Pwu, Raoh-fang, 蒲若芳
• Other Authors: H. Sung Kuo
• Format: Others
• Language: zh-TW
• Published: 1993
• Online Access: http://ndltd.ncl.edu.tw/handle/91300165886009153387

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.