Utilization of hepatocellular carcinoma surveillance in the United States.
174 Background: Surveillance for hepatocellular carcinoma is recommended in high-risk patients, but several studies have suggested it is being underutilized.The aim of this study is to quantify utilization rates for HCC surveillance among patients with cirrhosis and summarize patterns of association between utilization rates and patient and clinic characteristics. Methods: A systematic literature review using the Medline database and national meeting abstracts identified all cohort studies that described HCC surveillance rates among at-risk patients in the United States. Two investigators independently extracted data on patient populations, study methods, and results. A pooled surveillance rate with 95% confidence intervals was calculated. Pre-specified subgroup analysis was performed to find correlates of surveillance utilization. Results: We identified 9 studies that met all inclusion criteria. There were a variety of definitions for surveillance among the studies, with only 4 assessing surveillance every 6-12 months as recommended by the AASLD guidelines. The pooled surveillance rate was 18.4% (95% CI 17.8% - 19.0%). Surveillance rates were significantly higher among patients followed in gastroenterology clinics compared to those followed in primary care clinics (51.7% vs. 16.9%, p< 0.001). Elderly, non-Caucasians, and people of low socioeconomic status had lower surveillance rates than their counterparts. Current studies fail to identify specific reasons for the underutilization of HCC surveillance. Conclusions: Utilization rates for HCC surveillance are low, although they are significantly higher among patients followed in subspecialty clinics. Appropriate intervention targets to increase surveillance rates and reduce socio-demographic disparities have not been identified to date, and this should be a primary goal for future studies.