Financial Burden of Hepatocellular Carcinoma Screening in Patients With Cirrhosis

BACKGROUND: The overall value of hepatocellular carcinoma screening is de fi ned by the balance of bene fi ts and harms. Studies have only reported physical harms with none describing fi nancial harms. METHODS: We conducted a multicenter pragmatic randomized clinical trial of hepatocellular carcinoma screening outreach among 2872 patients with cirrhosis from March 2018 to April 2021. Patients with positive or indeterminate results and matched patients with negative results completed surveys at baseline and at follow-up measuring fi nancial harms via Cancer SelfAdministered Questionnaire and fi nancial burden via Comprehensive Score for Financial Toxicity Functional Assessment of Chronic Illness Therapy. Univariable and multivariable longitudinal regression analyses were performed to compare changes in fi nancial harms across groups: true positive, true negative, false positive, and indeterminate. Semistructured interviews were conducted in a subset of patients, sampled by center and test result. RESULTS: Of 311 patients who completed at least 1 follow-up survey (75% response rate), 37 had true positive, 133 true negative, 64 false positive, and 77 indeterminate results. Financial harms increased in true positive and false positive patients with no signi fi cant changes noted among those with true negative or indeterminate results. At follow-up, 21.8% of patients reported moderate-severe fi nancial burden, which was not signi fi cantly associated with test results. Semistructured interviews revealed variation in the frequency and severity of fi nancial harms based on test results, with increased harm in those with false positive results. CONCLUSIONS: Financial harms of hepatocellular carcinoma screening vary by test result and can pose a barrier that must be considered when determining the optimal screening program.