Hepatocellular carcinoma (HCC) imposes a significant health and economic burden on patients. Screening, recognized as an effective strategy to improve early diagnosis rates in high-risk populations, has garnered broad acknowledgment in the field. Current HCC screening techniques primarily rely on abdominal ultrasound (US) and alpha-fetoprotein (AFP) testing. However, these methods have limitations: the accuracy of ultrasound can be affected by subcutaneous fat thickness, and AFP has a relatively low detection rate for early-stage HCC.

Furthermore, the question of whether a single screening method can be broadly and effectively implemented in real-world settings remains open to debate. Effective screening strategies require balancing diagnostic accuracy with cost-effectiveness to ensure they are both scientifically and economically feasible. The need for more diverse, precise screening models and comprehensive evaluations of their real-world performance and costs has become increasingly urgent.

At the 2024 American Association for the Study of Liver Diseases (AASLD) Annual Meeting, Dr. Jinlin Hou’s team from the Hepatology Center at Southern Medical University’s Nanfang Hospital presented a study on the cost-effectiveness of aMAP (age-male-albumin-bilirubin-platelet) score-guided individualized HCC screening strategies in HBsAg-positive populations. This research, based on real-world data, was selected as an “Outstanding Poster Presentation” at the conference.

The aMAP score is a valuable tool for assessing hepatocellular carcinoma (HCC) risk in chronic liver disease patients, stratifying them into low, medium, and high-risk groups with distinct 5-year incidence rates. Despite its potential to tailor screening, real-world application and cost-effectiveness of aMAP-guided screening remain largely unexplored. This study aimed to address this gap using real-world data from 44,852 HBsAg-positive patients across 10 Chinese healthcare institutions.

A Markov decision tree model was developed to compare the 30-year cost-effectiveness of two screening strategies: Standard Screening (Strategy A), involving ultrasound (US) and alpha-fetoprotein (AFP) tests every six months, and aMAP-Guided Screening (Strategy B), where screening frequency varied by risk group (annually for low-risk, bi-annually for medium-risk, and quarterly for high-risk). The model integrated epidemiological, clinical, utility, and cost data from literature, real-world sources, and simulations. Sensitivity analyses ensured model robustness, adopting a healthcare provider perspective with a 5% discount rate and a willingness-to-pay threshold of $37,500.

The study population had a median age of 50 years, was 64.2% male, and had a median aMAP score of 49.8. Patients were categorized as low-risk (50.38%), medium-risk (29.66%), and high-risk (19.96%). Over 30 years, Strategy B cost 2,002perpersonandgenerated6.82quality−adjustedlifeyears(QALYs),outperformingStrategyA,whichcostanadditional914 per person for fewer QALYs (6.80). Sensitivity analysis confirmed Strategy B’s cost-effectiveness across various parameters, with a 99.9% probability of being cost-effective at the $37,500 threshold.

In conclusion, aMAP score-guided individualized HCC screening is more cost-effective than standard screening for HBsAg-positive individuals, highlighting the potential of personalized screening to optimize resource allocation. Future research aims to refine these findings.