Surveillance of hepatocellular carcinoma (HCC) patients using Protein Induced by Vitamin K (PIVKA-II): A cost-utility analysis for Hong Kong.
| Title: | Surveillance of hepatocellular carcinoma (HCC) patients using Protein Induced by Vitamin K (PIVKA-II): A cost-utility analysis for Hong Kong. |
|---|---|
| Authors: | Yuen MF; Department of Medicine, School of Clinical Medicine & State Key Laboratory of Liver Research, The University of Hong Kong and Queen Mary Hospital, Hong Kong, China.; Wastlund D; Vista Health Private Limited, Singapore, Singapore.; Lin TTY; Vista Health Private Limited, Singapore, Singapore.; Zheng Q; Roche Diagnostics (Asia Pacific) Limited, Singapore, Singapore.; Chen J; Roche Hong Kong Limited, Hong Kong SAR, China.; Ko KL; Department of Medicine, School of Clinical Medicine & State Key Laboratory of Liver Research, The University of Hong Kong and Queen Mary Hospital, Hong Kong, China. |
| Source: | PloS one [PLoS One] 2026 Jul 17; Vol. 21 (7), pp. e0353882. Date of Electronic Publication: 2026 Jul 17 (Print Publication: 2026). |
| Publication Type: | Journal Article |
| Language: | English |
| Journal Info: | Publisher: Public Library of Science Country of Publication: United States NLM ID: 101285081 Publication Model: eCollection Cited Medium: Internet ISSN: 1932-6203 (Electronic) Linking ISSN: 19326203 NLM ISO Abbreviation: PLoS One Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: San Francisco, CA : Public Library of Science |
| MeSH Terms: | Carcinoma, Hepatocellular*/diagnosis ; Carcinoma, Hepatocellular*/economics ; Carcinoma, Hepatocellular*/blood ; Liver Neoplasms*/diagnosis ; Liver Neoplasms*/economics ; Liver Neoplasms*/blood ; Biomarkers*/metabolism ; Protein Precursors*; alpha-Fetoproteins/metabolism ; alpha-Fetoproteins/analysis ; Humans ; Hong Kong ; Prothrombin ; Cost-Benefit Analysis ; Male ; Female ; Quality-Adjusted Life Years ; Middle Aged ; Cost-Effectiveness Analysis ; Liver Cirrhosis |
| Abstract: | Background & Aims: Hepatocellular carcinoma (HCC) is a leading cause of cancer-related death in Hong Kong. Common risk factors include chronic hepatitis B (CHB) infection and/ or liver cirrhosis (LC). Routine HCC surveillance using ultrasound plus alpha-fetoprotein (AFP) for patients with these conditions is recommended, but many patients still face limited access to ultrasound. For these, biomarker-based surveillance using a combination of protein induced by vitamin K absence or antagonist-II (PIVKA-II) plus AFP could provide a valuable alternative.; Methods: This study compared the cost-utility of routine HCC surveillance using 'PIVKA-II + AFP' to the recommended standard-of-care in Hong Kong: surveillance using 'US + AFP'. A health economic model using a Markov-microsimulation framework was adapted using published local data and settings. The model was used to compare diagnostic outcomes, overall costs, quality-adjusted life years (QALYs), and cost-utility of the alternative HCC surveillance methods.; Results: Compared to the current recommended standard-of-care, the results suggested that HCC surveillance using 'PIVKA-II + AFP' could improve detection of HCC during early-stage disease by 4.6 percentage points, thus enabling access to more effective treatment options for some patients. It could also reduce false positive diagnoses by 7.2%, which could alleviate the need for costly confirmatory testing. Overall, PIVKA-II + AFP' was associated with a gain of 0.019 QALYs and cost savings of HK $ 4,144 per individual. The results were particularly favorable for non-cirrhotic CHB patients.; Conclusions: HCC surveillance using 'PIVKA-II + AFP' could be a feasible option for patients with CHB and/ or LC who face limited access to ultrasound-based surveillance. The combination has the potential to improve early-stage HCC detection, facilitating timely intervention and improving both survival outcomes and patient quality of life.; (Copyright: © 2026 Yuen et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.) |
| Competing Interests: | have read the journal’s policy and the authors of this manuscript have the following competing interests: The health economic model used for this analysis was funded by Roche Diagnostics Asia Pacific Ltd, which also provided access to data on diagnostic accuracy. QZ and JC are previous employees of Roche Diagnostics. DW and TT are consultants at Vista Health, a company that have received funding from Roche Diagnostics for evaluating the cost-effectiveness of alternative HCC surveillance methods. MFY has received compensation at fair market value for his consultancy in model advisory boards of Roche Diagnostics and for delivering lectures organised by Roche Diagnostics. The opinions expressed in this publication are those of the authors and they do not necessarily reflect the view of the funder. |
| Substance Nomenclature: | 53230-14-1 (acarboxyprothrombin); 9001-26-7 (Prothrombin); 0 (Protein Precursors); 0 (Biomarkers); 0 (alpha-Fetoproteins) |
| Entry Date(s): | Date Created: 20260717 Date Completed: 20260717 Latest Revision: 20260726 |
| Update Code: | 20260726 |
| PubMed Central ID: | PMC13378965 |
| DOI: | 10.1371/journal.pone.0353882 |
| PMID: | 42467672 |
| Database: | MEDLINE |
Journal Article