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Effectiveness and cost-effectiveness of the national screening strategy for early detection of hepatocellular carcinoma among Egyptian cirrhotic patients cured from hepatitis C (Helwan University)
Egypt (IFMSA-Egypt) - Helwan University, Helwan
Prof Mohamed EL Kassas
Prof Mohamed EL Kassas
Type of Research Project
- Clinical Project without Laboratory work
What is the background of the project?
The annual risk of Hepatocellular carcinoma (HCC) is 3% to 8% among Hepatitis C virus (HCV)-infected individuals and 0.3 to 2.4% among HCV-cured patients with liver cirrhosis. HCC is indeed the most frequent cancer in Egypt, with incidence ranging from 13.1/100,000 Person-Year (PY) in the south, to 61.5/100,000 PY in the north . A recent epidemiological study has found that 83% of HCC are attributable to HCV, with median age at diagnosis of 58 years, and an overall median time survival of 10.9 months. In Egypt, HCC treatment options include resection, local ablation techniques including Radiofrequency ablation (RFA) and Microwave ablation (MWA), Transarterial chemoemoblization (TACE), Sorafenib and liver transplantation. However, some of these treatments options like Sorafenib and liver transplantation are not equally available across the country. The current Egyptian guidelines for HCC screening after antiviral therapy recommend liver ultrasound (US) and alpha-foetoprotein (AFP) measurement every 4 months for all patients with cirrhosis. Still, only 25% of patients are detected at early stage (stages 0 and A of the Barcelona Clinic Liver Cancer (BCLC)) However, the cost- effectiveness of this screening has not been evaluated and would be useful to policymakers in Egypt and in countries with similar epidemics and income level like Georgia, Pakistan or Mongolia
What is the aim of the project?
The main objective of this project is to estimate the effectiveness and cost-effectiveness of the screening strategy planned by Egyptian authorities for the early detection of HCC among cirrhotic patients treated for hepatitis C as part of the National HCV Treatment Program.
What techniques and methods are used?
During the first phase of the study, First phase will work on adapt the model structure and variables from Cadier et al. to the Egyptian context of HCC care, population characteristics, and treatment availability. For clinical data collection and standard of care modeling, working on the primary data from an HCC retrospective study. This study will describe retrospectively the presentation and survival for patient diagnosed with HCC between 2007 and 2017, and will aim at: • Identifying individual factors (in terms of gender, age, HCC etiology, co-morbidities, tumor stage at diagnosis, treatment) associated with survival, • Assessing the performance of the Barcelona clinical liver cancer (BCLC) staging system to predict patient survival, • Assessing temporal changes in the presentation and survival of patients with HCC over the study period in order to assess the indirect benefits of the recent large nationwide programme for combating HCV. • After the data collection and the construction of the model of natural history and standard of care of HCC in Egypt, we will calibrate the model to fit to the Egyptian data. Because initial coverage of HCC screening at baseline is not known, we will calibrate these data according to the proportion of HCC diagnosed at BCLC stage A, as reported by the HCC retrospective study and the literature • Finally, we will model the intervention by assessing the effect of an improvement of HCC screening coverage in the target population.
What is the role of the student?
- The student will observe the practical experiments but will be highly involved in the analysis of the results
- The tasks will be done under supervision
What are the tasks expected to be accomplished by the student?
• Incoming students will help in collecting and extracting data from HCC patients medical records including individual factors gender, age, HCC etiology, co-morbidities, tumor stage at diagnosis, treatmentgender, age, HCC etiology, co-morbidities, tumor stage at diagnosis, treatment • Will learn how to assess hepatocellular carcinoma according to BCLC • Can observe the statistical analysis if intereseted
Will there be any theoretical teaching provided (preliminary readings, lectures, courses, seminars etc)
lectures for the incoming student on basics of research will be provided by the tutor • Type of studies • How to fill (Corticotropin-releasing factor) CRF • Academic writing
What is expected from the student at the end of the research exchange? What will be the general outcome of the student?
- The student will prepare a scientific report
What skills are required of the student? Is there any special knowledge or a certain level of studies needed?
To be oriented about the basics of statistical analysis, Clinical examination, English medical terminology and to be passed in internal medicine.
Are there any legal limitations in the student’s involvement
Type of students accepted
This project accepts: - Medical students - Graduated students (less than 6 months) - Pre-Medical students from the American-British system
- Esmat G; El-Sayed MH; Hassany M; Doss W; Waked I. National committee for the control of viral hepatitis. One step closer to elimination of hepatitis C in Egypt. Lancet Gastroenterol Hepatol 2018; 3:665. Andersson KL; Salomon JA; Goldie SJ; Chung RT. Cost effectiveness of alternative surveillance strategies for hepatocellular carcinoma in patients with cirrhosis. Clin Gastroenterol Hepatol 2008; 6:1418–1424.
- Andersson KL; Salomon JA; Goldie SJ; Chung RT. Cost effectiveness of alternative surveillance strategies for hepatocellular carcinoma in patients with cirrhosis. Clin Gastroenterol Hepatol 2008; 6:1418–1424.
- Nasrullah M; Sergeenko D; Gvinjilia L; et al. The Role of screening and treatment in national progress toward hepatitis C elimination — Georgia; 2015–2016. MMWR Morb Mortal Wkly Rep 2017; 66:773– 776.
- El Kassas M; Funk AL; Salaheldin M; Shimakawa Y; Eltabbakh M; Jean K; El Tahan A; Sweedy AT; Afify S; Youssef NF; Esmat G; Fontanet A. Increased recurrence rates of hepatocellular carcinoma after DAA therapy in a hepatitis C-infected Egyptian cohort: A comparative analysis. J Viral Hepat. 2018 Jun;25(6):623-630.
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