{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T15:29:03Z","timestamp":1788535743525,"version":"build-2803163510"},"reference-count":30,"publisher":"Public Library of Science (PLoS)","issue":"1","license":[{"start":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T00:00:00Z","timestamp":1767571200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"The NSRF via the Program Management Unit for Human Resources & Institutional Development, Research and Innovation","award":["B38G670012"],"award-info":[{"award-number":["B38G670012"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Hepatocellular carcinoma (HCC) is the leading cause of cancer-related death in Thailand. However, most Thai patients at high risk of HCC lack access to routine surveillance programs. This study used ultrasound- or biomarker-based screening approaches to assess the cost-utility analysis of routine HCC surveillance in patients with compensated liver cirrhosis (CLC).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>The model utilized a Markov-style microsimulation framework to simulate outcomes from alternative HCC surveillance methods for Thai patients. The model was designed to represent Thai patients and healthcare as accurately as possible, and novel Thai patient data was used to estimate treatment and survival associated with screening. Outcomes included diagnostic performance, total costs, and overall health expressed as quality-adjusted life years (QALYs). The incremental cost-effectiveness ratio (ICER) was assessed according to the Thai willingness-to-pay threshold (\u0e3f160,000\u2009=\u20094,800 USD).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Results suggest that routine HCC surveillance is likely cost-effective in Thai patients with CLC. Among the biomarker-based approaches, GAAD score, which combined gender, age, alpha-fetoprotein (AFP), and des-gamma carboxyprothrombin (DCP), was the most cost-effective due to its high detection of HCC while resulting in comparably few false positive diagnoses. Compared to no routine surveillance, GAAD surveillance is suggested to be cost-effective (ICER: $4,631). Compared to ultrasound plus AFP \u2013 the recommended standard of care \u2013 GAAD is suggested to be dominant, resulting in better overall health at a lower cost.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Bi-annual routine HCC surveillance is suggested to be cost-effective for the Thai healthcare system when used for patients with CLC. Among biomarker-based approaches, GAAD appears to be the most cost-effective and could maximize the benefits of HCC surveillance in high-risk patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0337913","type":"journal-article","created":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T19:07:51Z","timestamp":1767640071000},"page":"e0337913","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":3,"title":["Economic evaluation of biomarker-based surveillance for Hepatocellular Carcinoma in Thai patients with Compensated Liver Cirrhosis"],"prefix":"10.1371","volume":"21","author":[{"given":"Nutcha","family":"Pinjaroen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9839-5359","authenticated-orcid":true,"given":"Wirichada","family":"Pan-Ngum","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kittiyod","family":"Poovorawan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5074-4740","authenticated-orcid":true,"given":"David","family":"Wastlund","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabian","family":"Mueller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-4773-5404","authenticated-orcid":true,"given":"Peng","family":"Lu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca 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