{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T18:04:31Z","timestamp":1784311471812,"version":"3.55.0"},"reference-count":51,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T00:00:00Z","timestamp":1784246400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100016545","name":"Roche Diagnostics","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100016545","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background &amp; Aims<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This study compared the cost-utility of routine HCC surveillance using \u2018PIVKA-II + AFP\u2019 to the recommended standard-of-care in Hong Kong: surveillance using \u2018US + AFP\u2019. 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Compared to the current recommended standard-of-care, the results suggested that HCC surveillance using \u2018PIVKA-II + AFP\u2019 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\u2019 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>HCC surveillance using \u2018PIVKA-II + AFP\u2019 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0353882","type":"journal-article","created":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T17:36:34Z","timestamp":1784309794000},"page":"e0353882","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Surveillance of hepatocellular carcinoma (HCC) patients using Protein Induced by Vitamin K (PIVKA-II): A cost-utility analysis for Hong Kong"],"prefix":"10.1371","volume":"21","author":[{"given":"Man-Fung","family":"Yuen","sequence":"first","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":"Tammie Tan Yan","family":"Lin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qishi","family":"Zheng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1790-5802","authenticated-orcid":true,"given":"Junqiao","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kwan-Lung","family":"Ko","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,7,17]]},"reference":[{"issue":"10","key":"pone.0353882.ref001","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1038\/s41575-019-0186-y","article-title":"A global view of hepatocellular carcinoma: trends, risk, prevention and management","volume":"16","author":"JD Yang","year":"2019","journal-title":"Nat Rev Gastroenterol Hepatol"},{"issue":"3","key":"pone.0353882.ref002","first-page":"229","article-title":"Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"74","author":"F Bray","year":"2024","journal-title":"CA Cancer J Clin"},{"key":"pone.0353882.ref003","unstructured":"Centre for Health Promotion. 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