Economic Evaluation of Serum PIVKA-II Testing in High Risk Liver Cancer Patients

Abstract

This article aimed to evaluate the cost-effectiveness of serum Alpha-fetoprotein (AFP) combined with PIVKA-II testing using a cost-utility analysis method, compared to the scenario without such testing. The study employed a Markov Model and utilized secondary data from empirical research both domestically and internationally. Furthermore, the study assessed the impact of the PIVKA-II testing on public health system in terms of access and coverage of health services and related budget allocation. The study found that without surveillance testing, the average cost per patient is 697,945.37 THB, with 16.68 life years gained (LYG) and 11.22 quality-adjusted life years (QALY). With surveillance testing, the cost drops to 258,505.77 THB, LYG increases to 20.27, and QALY rises to 14.36. Surveillance testing saves 439,439.60 THB per person, adds 3.59 LYG, and improves QALY by 3.14. The incremental cost-effectiveness ratio (ICER) is -139,926.85 THB per QALY, making it cost-effective per Thailand's 2021 criteria of 160,000 THB/QALY. Sensitivity analysis confirmed the economic viability of surveillance testing. Also, an evaluation on Thailand’s public health system found that in terms of access and coverage the PIVKA-II testing covers 23,920,647 individuals aged 40-99 incurs with total public budget of 23,442,234,060 Baht. 91 hospitals are expected to provide testing services to approximately 262,865 eligible individuals per hospital each year.