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Financial Burden of Hepatocellular Carcinoma Screening in Patients With Cirrhosis.

Authors :
Narasimman M
Hernaez R
Cerda V
Lee M
Yekkaluri S
Khan A
Sood A
Gurley T
Quirk L
Liu Y
Kramer JR
Lee SC
Tiro JA
Murphy CC
Singal AG
Source :
Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association [Clin Gastroenterol Hepatol] 2024 Apr; Vol. 22 (4), pp. 760-767.e1. Date of Electronic Publication: 2023 Aug 05.
Publication Year :
2024

Abstract

Background: The overall value of hepatocellular carcinoma screening is defined by the balance of benefits and harms. Studies have only reported physical harms with none describing financial harms.<br />Methods: We conducted a multicenter pragmatic randomized clinical trial of hepatocellular carcinoma screening outreach among 2872 patients with cirrhosis from March 2018 to April 2021. Patients with positive or indeterminate results and matched patients with negative results completed surveys at baseline and at follow-up measuring financial harms via Cancer Self-Administered Questionnaire and financial burden via Comprehensive Score for Financial Toxicity Functional Assessment of Chronic Illness Therapy. Univariable and multivariable longitudinal regression analyses were performed to compare changes in financial harms across groups: true positive, true negative, false positive, and indeterminate. Semistructured interviews were conducted in a subset of patients, sampled by center and test result.<br />Results: Of 311 patients who completed at least 1 follow-up survey (75% response rate), 37 had true positive, 133 true negative, 64 false positive, and 77 indeterminate results. Financial harms increased in true positive and false positive patients with no significant changes noted among those with true negative or indeterminate results. At follow-up, 21.8% of patients reported moderate-severe financial burden, which was not significantly associated with test results. Semistructured interviews revealed variation in the frequency and severity of financial harms based on test results, with increased harm in those with false positive results.<br />Conclusions: Financial harms of hepatocellular carcinoma screening vary by test result and can pose a barrier that must be considered when determining the optimal screening program.<br /> (Copyright © 2024 AGA Institute. Published by Elsevier Inc. All rights reserved.)

Details

Language :
English
ISSN :
1542-7714
Volume :
22
Issue :
4
Database :
MEDLINE
Journal :
Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association
Publication Type :
Academic Journal
Accession number :
37544418
Full Text :
https://doi.org/10.1016/j.cgh.2023.07.018