Hepatocellular carcinoma surveillance among cirrhotic patients with commercial health insurance

David S. Goldberg, Adriana Valderrama, Rajesh Kamalakar, Sujit S. Sansgiry, Svetlana Babajanyan, James D. Lewis

Research output: Contribution to journalArticlepeer-review

23 Scopus citations


Goals: To evaluate hepatocellular carcinoma (HCC) surveillance rates among commercially insured patients, and evaluate factors associated with compliance with surveillance recommendations. Background: Most HCC occurs in patients with cirrhosis. American Association for the Study of Liver Diseases and European Association for the Study of the Liver guidelines each recommend biannual HCC surveillance for cirrhotic patients to diagnose HCC at an early, curable stage. However, compliance with these guidelines in commercially insured patients is unknown. Study: We used the Truven Health Analytics databases from 2006 to 2010, using January 1, 2006 as the anchor date for evaluating outcomes. The primary outcome was continuous surveillance measure, defined as the proportion of time "up-to-date" with surveillance (PTUDS), with the 6-month interval immediately following each ultrasound categorized as "up-to-date." Results: During a median follow-up of 22.9 (interquartile range, 16.3 to 33.9) months among 8916 cirrhotic patients, the mean PTUDS was 0.34 (SD, 0.29), and the median was 0.31 (interquartile range, 0.03 to 0.52). These values increased only modestly with inclusion of serum alpha-fetoprotein testing, contrastenhanced abdominal computed tomographic scans or magnetic resonance imagings, and/or extension of up-to-date time to 12 months. Being diagnosed by a nongastroenterology provider and increasing age were significantly associated with decreased HCC surveillance (P<0.05), whereas a history of a hepatic decompensation event, presence of any component of the metabolic syndrome, and diagnosis of hepatitis B or hepatitis C were significantly associated with increased surveillance (P<0.05). However, even among patients with the most favorable characteristics, surveillance rates remained low. Conclusions: HCC surveillance rates in commercially insured atrisk patients remain poor despite formalized guidelines, highlighting the need to develop interventions to improve surveillance rates.

Original languageEnglish (US)
Pages (from-to)258-265
Number of pages8
JournalJournal of clinical gastroenterology
Issue number3
StatePublished - 2016
Externally publishedYes


  • Commercial insurance
  • Hepatocellular carcinoma
  • Surveillance rates

ASJC Scopus subject areas

  • Gastroenterology


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