• Amelia J Hessheimer, Ana Magdalena Vargas-Martínez, Marta Trapero-Bertrán, Miquel Navasa, and Constantino Fondevila.
• General & Digestive Surgery, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain.
• Ann. Surg. 2023 Feb 1; 277 (2): e359e365e359-e365.

ObjectiveAssess cost-effectiveness and -utility associated with posttransplant HCC surveillance compared to standard follow-up.Summary Of Background DataDespite lack of prospective clinical data, expert consensus recommends posttransplant surveillance to detect HCC recurrence in a latent phase, while it might be amenable to curative-intent therapy.MethodsA Markov-based transition model was created to estimate life expectancy and quality-of-life among liver transplant patients undergoing HCC surveillance. Models were built for 2 cohorts: 1 undergoing HCC surveillance with contrast-enhanced computed tomography of chest and abdomen and serum alpha-fetoprotein analysis and the other receiving standard posttransplant follow-up. Primary model outputs included LY and QALY gains, incremental cost-effectiveness ratio, and incremental cost-utility ratio. Willingness-to-pay for a QALY gain (cost-effectiveness threshold) was used to estimate efficiency.ResultsSurveillance was marginally more effective versus no surveillance, resulting in means of 0.069 LYs and 0.026 QALYs gained. Costs for surveillance were increased by an average of 988.32€, resulting in incremental cost-effectiveness ratio 14,410.15€/LY and incremental cost-utility ratio 37,547.97€/QALY. Surveillance did not seem cost-effective in our setting, considering willingness-to-pay threshold of 25,000€/QALY. Probabilistic sensitivity analysis indicated surveillance might be cost-effective in 42% of cases, but degree of uncertainty in the analysis was high.ConclusionsPerforming posttransplant HCC surveillance offers marginal clinical benefits and increases costs. Although expert consensus supports surveillance, results of this decision analysis raise doubt regarding the utility of such recommendations and support ongoing need for prospective clinical trials.Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

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