DOI QR코드

DOI QR Code

Economic Evaluation and Budget Impact Analysis of the Surveillance Program for Hepatocellular Carcinoma in Thai Chronic Hepatitis B Patients

  • Sangmala, Pannapa (Social and Administrative Pharmacy Excellence Research (SAPER) Unit, Department of Pharmacy, Faculty of Pharmacy, Mahidol University) ;
  • Chaikledkaew, Usa (Social and Administrative Pharmacy Excellence Research (SAPER) Unit, Department of Pharmacy, Faculty of Pharmacy, Mahidol University) ;
  • Tanwandee, Tawesak (Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Siriraj Hospital) ;
  • Pongchareonsuk, Petcharat (Social and Administrative Pharmacy Excellence Research (SAPER) Unit, Department of Pharmacy, Faculty of Pharmacy, Mahidol University)
  • Published : 2014.11.06

Abstract

Background: The incidence rate and the treatment costs of hepatocellular carcinoma (HCC) are high, especially in Thailand. Previous studies indicated that early detection by a surveillance program could help by down-staging. This study aimed to compare the costs and health outcomes associated with the introduction of a HCC surveillance program with no program and to estimate the budget impact if the HCC surveillance program were implemented. Materials and Methods: A cost utility analysis using a decision tree and Markov models was used to compare costs and outcomes during the lifetime period based on a societal perspective between alternative HCC surveillance strategies with no program. Costs included direct medical, direct non-medical, and indirect costs. Health outcomes were measured as life years (LYs), and quality adjusted life years (QALYs). The results were presented in terms of the incremental cost-effectiveness ratio (ICER) in Thai THB per QALY gained. One-way and probabilistic sensitivity analyses were applied to investigate parameter uncertainties. Budget impact analysis (BIA) was performed based on the governmental perspective. Results: Semi-annual ultrasonography (US) and semi-annual ultrasonography plus alpha-fetoprotein (US plus AFP) as the first screening for HCC surveillance would be cost-effective options at the willingness to pay (WTP) threshold of 160,000 THB per QALY gained compared with no surveillance program (ICER=118,796 and ICER=123,451 THB/QALY), respectively. The semi-annual US plus AFP yielded more net monetary benefit, but caused a substantially higher budget (237 to 502 million THB) than semi-annual US (81 to 201 million THB) during the next ten fiscal years. Conclusions: Our results suggested that a semi-annual US program should be used as the first screening for HCC surveillance and included in the benefit package of Thai health insurance schemes for both chronic hepatitis B males and females aged between 40-50 years. In addition, policy makers considered the program could be feasible, but additional evidence is needed to support the whole prevention system before the implementation of a strategic plan.

Keywords

Cost-utility analysis;HCC;hepatitis B;early detection;policy formulation;budget impact analysis

References

  1. Bouza C, Lopez-Cuadrado T, Alcazar R, et al (2009). Metaanalysis of percutaneous radiofrequency ablation versus ethanol injection in hepatocellular carcinoma. BMC Gastroenterol, 9, 31. https://doi.org/10.1186/1471-230X-9-31
  2. Amarapurkar D, Han KH, Chan HL, et al (2009). Application of surveillance programs for hepatocellular carcinoma in the Asia-Pacific Region. J Gastroenterol Hepatol, 24, 955-61. https://doi.org/10.1111/j.1440-1746.2009.05805.x
  3. Andersson KL, Salomon JA, Goldie SJ, et al. (2008). Cost effectiveness of alternative surveillance strategies for hepatocellular carcinoma in patients with cirrhosis. Clin Gastroenterol Hepatol, 6, 1418-24. https://doi.org/10.1016/j.cgh.2008.08.005
  4. Bennett GL, Krinsky GA, Abitbol RJ, et al (2002). Sonographic detection of hepatocellular carcinoma and dysplastic nodules in cirrhosis: correlation of pretransplantation sonography and liver explant pathology in 200 patients. Am J Roentgenol, 179, 75-80. https://doi.org/10.2214/ajr.179.1.1790075
  5. Bhartia B, Ward J, Guthrie JA, et al (2003). Hepatocellular carcinoma in cirrhotic livers: double-contrast thin-section MR imaging with pathologic correlation of explanted tissue. AJR Am J Roentgenol, 180, 577-84. https://doi.org/10.2214/ajr.180.3.1800577
  6. Bolondi L, Sofia S, Siringo S, et al (2001). Surveillance programme ofCIrrhotic patients for early diagnosis and treatment of hepatocellular carcinoma: a cost effectiveness analysis. Gut, 48, 251-9. https://doi.org/10.1136/gut.48.2.251
  7. Bruix J, Sherman M (2005). Management of hepatocellular carcinoma. Hepatology, 42, 1208-36. https://doi.org/10.1002/hep.20933
  8. Bruix J, Sherman M (2011). Management of hepatocellular carcinoma: an update. Hepatology, 53, 1020-2. https://doi.org/10.1002/hep.24199
  9. Bureau of Epidemiology-Department of Disease Control Ministry of Public Health (2013). Epidemiology and surveillance of hepatitis B Report 506 [Online]. Available: http://www.boe.moph.go.th/boedb/surdata/506wk/y56/d12_4056.pdf [Accessed Oct 10, 2013].
  10. Bureau of Trade and Economic Indices-Ministry of Commerce (2013). Consumer Price Index (CPI): medical care [Online]. Available: (http://www.indexpr.moc.go.th/price_present/tableIndexCpi_y_bot.asp) [Accessed May 12, 2013].
  11. Burrel M, Llovet JM, Ayuso C, et al (2003). MRI angiography is superior to helical CT for detection of HCC prior to liver transplantation: an explant correlation. Hepatology, 38, 1034-42. https://doi.org/10.1002/hep.1840380430
  12. Chen MS, Li JQ, Zheng Y, et al (2006). A prospective randomized trial comparing percutaneous local ablative therapy and partial hepatectomy for small hepatocellular carcinoma. Ann Surg, 243, 321-8. https://doi.org/10.1097/01.sla.0000201480.65519.b8
  13. Cabibbo G, Enea M, Attanasio M, et al (2010). A meta-analysis of survival rates of untreated patients in randomized clinical trials of hepatocellular carcinoma. Hepatology, 51, 1274-83. https://doi.org/10.1002/hep.23485
  14. Chamadol N, Somsap K, Laopaiboon V, et al (2013). Sonographic findings of hepatocellular carcinoma detected in ultrasound surveillance ofCIrrhotic patients. J Med Assoc Thai, 96, 829-38.
  15. Chen JW, Kow L, Verran DJ, et al (2009). Poorer survival in patients whose explanted hepatocellular carcinoma (HCC) exceeds Milan or UCSF Criteria. An analysis of liver transplantation in HCC in Australia and New Zealand. HPB, 11, 81-9. https://doi.org/10.1111/j.1477-2574.2009.00022.x
  16. Cheng AL, Kang YK, Chen Z, et al (2009). Efficacy and safety of sorafenib in patients in the Asia-Pacific region with advanced hepatocellular carcinoma: a phase III randomised, double-blind, placebo-controlled trial. Lancet Oncol, 10, 25-34. https://doi.org/10.1016/S1470-2045(08)70285-7
  17. Chun JM, Kwon HJ, Sohn J, et al (2011). Prognostic factors after early recurrence in patients who underwent curative resection for hepatocellular carcinoma. J Surg Oncol, 103, 148-51. https://doi.org/10.1002/jso.21786
  18. Chung YH (2005). A strategy for early detection of recurrent hepatocellular carcinoma following initial remission by transcatheter arterial chemoembolization. Intervirology, 48, 46-51. https://doi.org/10.1159/000082094
  19. de Ledinghen V, Laharie D, Lecesne R, et al (2002). Detection of nodules in liver cirrhosis: spiral computed tomography or magnetic resonance imaging? A prospective study of 88 nodules in 34 patients. Eur J Gastroenterol Hepatol, 14, 159-65. https://doi.org/10.1097/00042737-200202000-00010
  20. DMSIC (2013). Manufacturer price estimate [Online]. Available: http://dmsic.moph.go.th/price.htm [Accessed Sep 13, 2013].
  21. Ferlay J, Shin HR, Bray F, et al (2010). Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer, 127, 2893-917. https://doi.org/10.1002/ijc.25516
  22. El-Serag HB (2012). Epidemiology of viral hepatitis and hepatocellular carcinoma. Gastroenterology, 142, 1264-73. https://doi.org/10.1053/j.gastro.2011.12.061
  23. Farrell GC, Chan HL, Yuen MF, et al (2010). Prevention of hepatocellular carcinoma in the Asia-Pacific region: consensus statements. J Gastroenterol Hepatol, 25, 657-63. https://doi.org/10.1111/j.1440-1746.2009.06167.x
  24. Fattovich G, Bortolotti F.Donato F (2008). Natural history of chronic hepatitis B: special emphasis on disease progression and prognostic factors. J Hepatol, 48, 335-52. https://doi.org/10.1016/j.jhep.2007.11.011
  25. Flores A, Marrero JA (2014). Emerging trends in hepatocellular carcinoma: focus on diagnosis and therapeutics. Clin Med Insights Oncol, 8, 71-6.
  26. Forner A, Llovet JM.Bruix J (2012). Hepatocellular carcinoma. Lancet, 379, 1245-55. https://doi.org/10.1016/S0140-6736(11)61347-0
  27. Gambarin-Gelwan M, Wolf DC, Shapiro R, et al (2000). Sensitivity of commonly available screening tests in detecting hepatocellular carcinoma inCIrrhotic patients undergoing liver transplantation. Am J Gastroenterol, 95, 1535-8. https://doi.org/10.1111/j.1572-0241.2000.02091.x
  28. Giannini EG, Cucchetti A, Erroi V, et al (2013). Surveillance for early diagnosis of hepatocellular carcinoma: how best to do it? World J Gastroenterol, 19, 8808-21. https://doi.org/10.3748/wjg.v19.i47.8808
  29. Han KH, Kudo M, Ye SL, et al (2011). Asian consensus workshop report: expert consensus guideline for the management of intermediate and advanced hepatocellular carcinoma in Asia. Oncology, 81, 158-64.
  30. Health Intervention and Technology Assessment Program (2009). Guidelines for Health Technology Assessment in Thailand, Bangkok, (in Thai).
  31. Hu M.Chen W (2009). Assessment of total economic burden of chronic hepatitis B (CHB)-related diseases in Beijing and Guangzhou, China. Value Health, 12, 89-92.
  32. Kim CK, Lim JH.Lee WJ (2001). Detection of hepatocellular carcinomas and dysplastic nodules inCIrrhotic liver: accuracy of ultrasonography in transplant patients. J Ultrasound Med, 20, 99-104.
  33. Hutton DW, Brandeau ML, So SK (2011). Doing Good with Good OR: supporting cost-effective hepatitis b interventions. Interfaces (Providence), 41, 289-300.
  34. Institute of Medical Research and Technology Assessment-Ministry of Public Health (2008). Cost-effectiveness of alpha-fetoprotein and liver ultrasound for semi-annual hepatocellular carcinoma screening in human with hepatitis b surface antigen positive or patients with chronic hepatitis b [Online]. Available: http://www.dms.moph.go.th/imrta/images/ebook/ta_doc/4.pdf [Accessed Oct 24, 2013].
  35. Kao WY, Su CW, Chau GY, et al (2011). A comparison of prognosis between patients with hepatitis B and C virusrelated hepatocellular carcinoma undergoing resection surgery. World J Surg, 35, 858-67. https://doi.org/10.1007/s00268-010-0928-z
  36. Kim KM, Kim JH, Park IS, et al (2009). Reappraisal of repeated transarterial chemoembolization in the treatment of hepatocellular carcinoma with portal vein invasion. J Gastroenterol Hepatol, 24, 806-14. https://doi.org/10.1111/j.1440-1746.2008.05728.x
  37. Kim YS, Lim HK, Rhim H, et al (2013). Ten-year outcomes of percutaneous radiofrequency ablation as first-line therapy of early hepatocellular carcinoma: analysis of prognostic factors. J Hepatol, 58, 89-97. https://doi.org/10.1016/j.jhep.2012.09.020
  38. Kobayashi K, Sugimoto T, Makino H, et al (1985). Screening methods for early detection of hepatocellular carcinoma. Hepatology, 5, 1100-5. https://doi.org/10.1002/hep.1840050607
  39. Krinsky GA, Lee VS, Theise ND, et al (2001). Hepatocellular carcinoma and dysplastic nodules in patients with cirrhosis: prospective diagnosis with MR imaging and explantation correlation. Radiology, 219, 445-54. https://doi.org/10.1148/radiology.219.2.r01ma40445
  40. Lim JH, Kim CK, Lee WJ, et al (2000). Detection of hepatocellular carcinomas and dysplastic nodules inCIrrhotic livers: accuracy of helical CT in transplant patients. AJR Am J Roentgenol, 175, 693-8. https://doi.org/10.2214/ajr.175.3.1750693
  41. Lee JK, Chung YH, Song BC, et al. (2002). Recurrences of hepatocellular carcinoma following initial remission by transcatheter arterial chemoembolization. J Gastroenterol Hepatol, 17, 52-8. https://doi.org/10.1046/j.1440-1746.2002.02664.x
  42. Levy AR, Kowdley KV, Iloeje U, et al (2008). The impact of chronic hepatitis B on quality of life: a multinational study of utilities from infected and uninfected persons. Value Health, 11, 527-38. https://doi.org/10.1111/j.1524-4733.2007.00297.x
  43. Libbrecht L, Bielen D, Verslype C, et al (2002). Focal lesions inCIrrhotic explant livers: pathological evaluation and accuracy of pretransplantation imaging examinations. Liver Transpl, 8, 749-61. https://doi.org/10.1053/jlts.2002.34922
  44. Lim KC, Chow PK, Allen JC, et al (2012). Systematic review of outcomes of liver resection for early hepatocellular carcinoma within the Milan criteria. Br J Surg, 99, 1622-9. https://doi.org/10.1002/bjs.8915
  45. Llovet JM, Ricci S, Mazzaferro V, et al (2008). Sorafenib in advanced hepatocellular carcinoma. N Engl J Med, 359, 378-90. https://doi.org/10.1056/NEJMoa0708857
  46. Ma QS, Zou YH, Zhang SX, et al (2011). Estimation on the intangible cost and influencing factors for patients with hepatitis B-related diseases. Zhonghua Liu Xing Bing Xue Za Zhi, 32, 764-7 (in Chinese).
  47. Ma YT.Palmer DH (2012). Impact of restricting access to highcost medications for hepatocellular carcinoma. Expert Rev Pharmacoecon Outcomes Res, 12, 465-73. https://doi.org/10.1586/erp.12.33
  48. Mantovani LG.Strazzabosco M (2013). Healthcare costs associated with hepatocellular carcinoma and the value of care. Hepatology, 58, 1213-4. https://doi.org/10.1002/hep.26645
  49. Misnistry of Public Health (2007). The purchasing price announcement of monopoly drugs from the Ministry of Public Health, Thailand [Online]. Available: http://dmsic.moph.go.th/download/circular2553/Contract_Monopoly53/MonopolyBargainPriceAnnounce_210953.pdf [Accessed Sep 4, 2013].
  50. Maringhini A, Cottone M, Sciarrino E, et al (1984). Ultrasonographic and radionuclide detection of hepatocellular carcinoma inCIrrhotics with low alpha-fetoprotein levels. Cancer, 54, 2924-6. https://doi.org/10.1002/1097-0142(19841215)54:12<2924::AID-CNCR2820541218>3.0.CO;2-F
  51. Marrero JA, Su GL, Wei W, et al (2003). Des-gamma carboxyprothrombin can differentiate hepatocellular carcinoma from nonmalignant chronic liver disease in american patients. Hepatology, 37, 1114-21. https://doi.org/10.1053/jhep.2003.50195
  52. Meissner HI, Smith RA, Rimer BK, et al (2004). Promoting cancer screening: Learning from experience. Cancer, 101, 1107-17. https://doi.org/10.1002/cncr.20507
  53. Mori K, Scheidler J, Helmberger T, et al (2002). Detection of malignant hepatic lesions before orthotopic liver transplantation: accuracy of ferumoxides-enhanced MR imaging. Am J Roentgenol, 179, 1045-51. https://doi.org/10.2214/ajr.179.4.1791045
  54. National Cancer Institute-Ministry of Public Health. 2011. Screening and management of Hepatocellular carcinoma and cholangiocarcinoma [Online]. Available: http://www.nci.go.th/th/cpg/download%20Liver/01.pdf [Accessed Oct 24, 2013].
  55. National Economic and Social Development Board. 2013. Number of population from population projections by age group and sex: 1990-2020 [Online]. Available: http://service.nso.go.th/nso/nso_center/project/table/files/0101200/2563/000/00_0101200_2563_000_000000_00200.xls [Accessed Oct 10, 2013].
  56. Okazaki N, Yoshida T, Yoshino M, et al (1984). Screening of patients with chronic liver disease for hepatocellular carcinoma by ultrasonography. Clin Oncol, 10, 241-6.
  57. Patel M, Shariff MI, Ladep NG, et al (2012). Hepatocellular carcinoma: diagnostics and screening. J Eval Clin Pract, 18, 335-42. https://doi.org/10.1111/j.1365-2753.2010.01599.x
  58. Riewpaiboon A (2009). Standard Cost Lists for Health Technology Assessment [Online]. Available: http://www.hitap.net/costingmenu/ [Accessed October 25, 2013].
  59. Permsuwan U, Guntawongwan K.Buddhawongsa P (2014). Handling times in economic evaluation studies. J. Med Assoc Thai, 97, 50-8.
  60. Peterson MS, Baron RL, Marsh JW Jr, et al (2000). Pretransplantation surveillance for possible hepatocellular carcinoma in patients with cirrhosis: epidemiology and CT-based tumor detection rate in 430 cases with surgical pathologic correlation. Radiology, 217, 743-9. https://doi.org/10.1148/radiology.217.3.r00dc28743
  61. Poon D, Anderson BO, Chen LT, et al (2009). Management of hepatocellular carcinoma in Asia: consensus statement from the Asian Oncology Summit 2009. Lancet Oncol, 10, 1111-8. https://doi.org/10.1016/S1470-2045(09)70241-4
  62. Rode A, Bancel B, Douek P, et al. (2001). Small nodule detection inCIrrhotic livers: evaluation with US, spiral CT, and MRI and correlation with pathologic examination of explanted liver. J Comput Assist Tomogr, 25, 327-36. https://doi.org/10.1097/00004728-200105000-00001
  63. Ryder SD (2003). Guidelines for the diagnosis and treatment of hepatocellular carcinoma (HCC) in adults. Gut, 52, 1-8. https://doi.org/10.1136/gut.52.1.1
  64. Sangmala P, Chaikledkaew U, Tanwandee T (2012). Systematic review of economic evaluation of the surveillance programs for Hepatocellular Carcinoma (HCC) in chronic hepatitis B patients. Mu J Pharm, 39, 33-7.
  65. Sawhney S, Montano-Loza AJ, Salat P, et al (2011). Transarterial chemoembolization in patients with hepatocellular carcinoma: predictors of survival. Can J Gastroenterol, 25, 426-32.
  66. Sherman M (2007). Surveillance for hepatocellular carcinoma and early diagnosis. Clin Liver Dis, 11, 817-37 https://doi.org/10.1016/j.cld.2007.08.011
  67. Shih ST, Crowley S.Sheu JC (2010). Cost-effectiveness analysis of a two-stage screening intervention for hepatocellular carcinoma in Taiwan. J Formos Med Assoc, 109, 39-55. https://doi.org/10.1016/S0929-6646(10)60020-4
  68. Thein HH, Walter SR, Gidding HF, et al (2012). Survival after diagnosis of hepatocellular carcinoma and potential impact of treatment in a hepatitis B or C infected cohort. Hepatol Res, 42, 1175-86. https://doi.org/10.1111/j.1872-034X.2012.01037.x
  69. Somboon K, Siramolpiwat S.Vilaichone RK (2014). Epidemiology and survival of hepatocellular carcinoma in the central region of Thailand. Asian Pac J Cancer Prev, 15, 3567-70. https://doi.org/10.7314/APJCP.2014.15.8.3567
  70. Song do S.Bae SH (2012). Changes of guidelines diagnosing hepatocellular carcinoma during the last ten-year period. Clin Mol Hepatol, 18, 258-67. https://doi.org/10.3350/cmh.2012.18.3.258
  71. Tang A, Cruite I.Sirlin CB (2013). Toward a standardized system for hepatocellular carcinoma diagnosis using computed tomography and MRI. Expert Rev Gastroenterol Hepatol, 7, 269-79. https://doi.org/10.1586/egh.13.3
  72. Thompson Coon J, Rogers G, Hewson P, et al (2008). Surveillance of cirrhosis for hepatocellular carcinoma: a cost-utility analysis. Br J Cancer, 98, 1166-75. https://doi.org/10.1038/sj.bjc.6604301
  73. Tong MJ, Blatt LM.Kao VW (2001). Surveillance for hepatocellular carcinoma in patients with chronic viral hepatitis in the United States of America. J Gastroenterol Hepatol, 16, 553-9. https://doi.org/10.1046/j.1440-1746.2001.02470.x
  74. Tong MJ, Sun HE, Hsien C, et al (2010). Surveillance for hepatocellular carcinoma improves survival in Asian-American patients with hepatitis B: results from a community-based clinic. Dig Dis Sci, 55, 826-35. https://doi.org/10.1007/s10620-009-1059-y
  75. Trevisani F, D'Intino PE, Morselli-Labate AM, et al (2001). Serum alpha-fetoprotein for diagnosis of hepatocellular carcinoma in patients with chronic liver disease: influence of HBsAg and anti-HCV status. J Hepatol, 34, 570-5. https://doi.org/10.1016/S0168-8278(00)00053-2
  76. Veldhuijzen IK, Toy M, Hahne SJ, et al (2010). Screening and early treatment of migrants for chronic hepatitis B virus infection is cost-effective. Gastroenterology, 138, 522-30. https://doi.org/10.1053/j.gastro.2009.10.039
  77. World Bank. 2013. PPP conversion factor (GDP) to market exchange rate ratio [Online]. Available: http://data.worldbank.org/indicator/PA.NUS.PPPC.RF [Accessed August 21, 2014].
  78. Vimolket T.Poovorawan Y (2005). An economic evaluation of universal infant vaccination strategies against hepatitis B in Thailand: an analytic decision approach to costeffectiveness. Southeast Asian J Trop Med Public Health, 36, 693-9.
  79. Wiangnon S, Kamsa-Ard S, Suwanrungruang K, et al (2012). Trends in incidence of hepatocellular carcinoma, 1990 - 2009, khon kaen, Thailand. Asian Pac J Cancer Prev, 13, 1065-8. https://doi.org/10.7314/APJCP.2012.13.3.1065
  80. Wichajarn K, Kosalaraksa P, Wiangnon S (2008). Incidence of hepatocellular carcinoma in children in Khon Kaen before and after national hepatitis B vaccine program. Asian Pac J Cancer Prev, 9, 507-9.
  81. Yang B, Zhang B, Xu Y, et al (1997). Prospective study of early detection for primary liver cancer. J Cancer Res Clin Oncol, 123, 357-60. https://doi.org/10.1007/BF01438313
  82. Yeo Y, Gwack J, Kang S, et al (2013). Viral hepatitis and liver cancer in Korea: an epidemiological perspective. Asian Pac J Cancer Prev, 14, 6227-31. https://doi.org/10.7314/APJCP.2013.14.11.6227
  83. Yeung YP, Lo CM, Liu CL, et al (2005). Natural history of untreated nonsurgical hepatocellular carcinoma. Am J Gastroenterol, 100, 1995-2004. https://doi.org/10.1111/j.1572-0241.2005.00229.x
  84. Zacherl J, Pokieser P, Wrba F, et al (2002). Accuracy of multiphasic helical computed tomography and intraoperative sonography in patients undergoing orthotopic liver transplantation for hepatoma: what is the truth? Ann Surg, 235, 528-32. https://doi.org/10.1097/00000658-200204000-00011
  85. Zamora J, Abraira V, Muriel A, et al (2006). Meta-DiSc: a software for meta-analysis of test accuracy data. BMC Med Res Methodol, 6, 31. https://doi.org/10.1186/1471-2288-6-31
  86. Zhou Y, Sui C, Li B, et al (2010a). Repeat hepatectomy for recurrent hepatocellular carcinoma: a local experience and a systematic review. World J Surg Oncol, 8, 55. https://doi.org/10.1186/1477-7819-8-55
  87. Zhou Y, Zhao Y, Li B, et al (2010b). Meta-analysis of radiofrequency ablation versus hepatic resection for small hepatocellular carcinoma. BMC Gastroenterol, 10, 78. https://doi.org/10.1186/1471-230X-10-78

Cited by

  1. Preparation and Characterization of Anti-GP73 Monoclonal Antibodies and Development of Double-antibody Sandwich ELISA vol.16, pp.5, 2015, https://doi.org/10.7314/APJCP.2015.16.5.2043
  2. The High Expressed Serum Soluble Neural Cell Adhesion Molecule, a High Risk Factor Indicating Hepatic Encephalopathy in Hepatocelular Carcinoma Patients vol.16, pp.8, 2015, https://doi.org/10.7314/APJCP.2015.16.8.3131
  3. CYP2C19 Genotype Could be a Predictive Factor for Aggressive Manifestations of Hepatocellular Carcinoma Related with Chronic Hepatitis B Infection in Thailand vol.16, pp.8, 2015, https://doi.org/10.7314/APJCP.2015.16.8.3253
  4. Hepatocellular carcinoma screening and surveillance in 2293 chronic hepatitis B patients in an endemic area vol.22, pp.34, 2016, https://doi.org/10.3748/wjg.v22.i34.7806
  5. Economic Evaluation and Budget Impact Analysis of Vaccination against Haemophilus influenzae Type b Infection in Thailand vol.5, pp.2296-2565, 2017, https://doi.org/10.3389/fpubh.2017.00289