Liver cancer is the only cancer in Australia to have both rising incidence and mortality rates. Liver cancer survival is low but curative treatment is available if detected early, and many liver cancers are caused by modifiable risk factors. The most common type of liver cancer is hepatocellular carcinoma (HCC); approximately a quarter of these are associated with overweight or obesity, and this proportion is expected to increase. Metabolic-associated fatty liver disease (MAFLD), linked to excess body fatness and the metabolic syndrome, develops in these patients before HCC; MAFLD is typically preventable with behavioral interventions.
This study aimed to assess primary and secondary prevention interventions for obesity and MAFLD-related HCC and determine their potential impact on the liver cancer burden in Australia and cost-effectiveness.
We developed Policy1-Liver, a model of MAFLD and liver cancer, to assess the potential health and economic impact of prevention. Primary prevention was modelled as once-off reduction of patient body weight by 10% to assess the potential of weight loss interventions. Secondary prevention uses HCC ultrasound surveillance for high-risk people, triaged using FIB-4, a non-invasive and accessible blood test.
By 2045, up to an estimated 150 MAFLD-related HCC deaths could be prevented annually through routine HCC surveillance in Australia. A once-off 10% weight reduction intervention in 2023 or at age 40, whichever occurs first, would have the potential to prevent up to 417 MAFLD-related HCC deaths. If the once-off weight loss intervention was coupled with routine HCC surveillance, this would further increase to 485.
Routine surveillance alone for most MAFLD patients would not be cost-effective, as many low-risk patients who would not benefit from surveillance. However, surveillance would be cost-effective for MAFLD patients with more advanced liver disease such as high levels of fibrosis. Further triaging to exclude low-risk MAFLD patients would improve the cost-effectiveness of HCC surveillance.
Currently, Australian clinical guidelines only recommend routine surveillance for patients whose liver is already cirrhotic given the limited evidence. As overweight and obesity rates in Australia climb, the burden of MAFLD-related liver cancer will continue to grow – however, providing HCC surveillance for all MAFLD patients is unlikely to be cost-effective and will generate significant resource demand. Using non-invasive technologies to identify patients at higher risk alongside primary prevention interventions will improve the feasibility of widespread HCC surveillance.