{"doi":"10.1016/j.eclinm.2025.103113","title":"Cost-effectiveness of an outreach program for HCC screening in patients with cirrhosis: a microsimulation modeling study","abstract":"Background: Patients with cirrhosis are at high risk for hepatocellular carcinoma (HCC), but few undergo guideline-recommended semi-annual screening. Randomized clinical trials (RCTs) demonstrate that mailed outreach can increase screening versus visit-based screening. We estimated the costs and cost-effectiveness of an outreach strategy versus usual care. Methods: We built a 10-year Markov chain Monte Carlo microsimulation model to conduct a cost-effectiveness analysis comparing a mailed outreach program versus usual care for HCC screening in a cohort of 10,000 patients with cirrhosis. Model inputs were based on literature review (2005-current), and costs were based on inflation-adjusted estimates from Surveillance, Epidemiology, and End Results (SEER)-Medicare claims data. We conducted one-way sensitivity analyses for HCC incidence, outreach costs, efficacy of the outreach strategy to increase screening, and efficacy of curative (versus palliative) HCC treatments. Findings: Mailed outreach was estimated to cost $32.45 per patient in the first year and $21.90 per patient in subsequent years. The outreach program increased the number of HCC patients detected at an early stage by 48.4% and increased quality-adjusted life years (QALYs) by 300. Cost savings from these increases offset the costs of mailed outreach. Mailed outreach remained cost-effective across a wide range of HCC incidence rates, outreach costs, efficacy of the outreach strategy to increase screening, and the efficacy of curative HCC treatments. Annual out-of-pocket patient costs in the outreach arm were low at $13 per year. Interpretation: Mailed outreach to encourage HCC screening in patients with cirrhosis dominates usual care and should be considered for implementation in routine practice. Funding: National Cancer Institute and Cancer Prevention Research Institute of Texas.","journal":"EClinicalMedicine","year":2025,"id":533282,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":2,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.7578,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":233861,"name":"Rubén Hernáez","orcid":"0000-0002-1518-4020","position":1,"is_corresponding":false},{"id":671582,"name":"Vanessa Cerda","orcid":null,"position":2,"is_corresponding":false},{"id":1415511,"name":"Tynaje Thomas","orcid":null,"position":3,"is_corresponding":false},{"id":839593,"name":"Manasa Narasimman","orcid":"0000-0001-6838-8054","position":4,"is_corresponding":false},{"id":652395,"name":"Sukul Mittal","orcid":null,"position":5,"is_corresponding":false},{"id":1415512,"name":"Mohammed Al-Hasan","orcid":null,"position":6,"is_corresponding":false},{"id":889115,"name":"Darine Daher","orcid":"0000-0002-9977-1176","position":7,"is_corresponding":false},{"id":106840,"name":"Amit G. Singal","orcid":"0000-0002-1172-3971","position":8,"is_corresponding":false},{"id":674817,"name":"Tami Gurley","orcid":null,"position":0,"is_corresponding":true}],"reference_count":62,"raw_metadata":null,"created_at":"2026-07-19T02:51:32.301795Z","pmid":"40040860","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}