Publication Name	World Journal of Gastroenterology
Manuscript ID	121840
DOI	10.3748/wjg.121840
Country	China

Category	Gastroenterology & Hepatology
Manuscript Type	Observational Study
Article Title	Cost-effectiveness of risk-stratified hepatocellular carcinoma screening using the age-male-albumin-bilirubin-platelets score-based stepwise enrichment approach in patients with cirrhosis
Manuscript Source	Unsolicited Manuscript
All Author List	Yun-Bo Zhang, Yu-Xuan Li, Wen-Di Zhang, Xian-Bin Hou, Rui Li, Ru-Yi Xia, Ming-Wang Shen, Zhuo-Ru Zou and Gui-Hua Zhuang
Funding Agency and Grant Number	Funding Agency Grant Number China National Science and Technology Major Project No. 2023ZD0501400 National Natural Science Foundation of China No. 82304206 China Postdoctoral Science Foundation No. BX20220254 China Postdoctoral Science Foundation No. 2023M732773
Corresponding Author	Gui-Hua Zhuang, PhD, Professor, Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, No. 76 Yanta West Road, Xi’an 710061, Shaanxi Province, China. zhuanggh@mail.xjtu.edu.cn
Key Words	Hepatocellular carcinoma; Screening; Age-male-albumin-bilirubin-platelets; Risk stratification; Cost-effectiveness; Cell-free deoxyribonucleic acid
Core Tip	This study developed a Markov model to evaluate the cost-effectiveness of risk-stratified hepatocellular carcinoma screening using age-male-albumin-bilirubin-platelets score-based stepwise enrichment approach in compensated cirrhosis. A total of 600 screening strategies were evaluated, combining whether to apply stratification with different screening frequencies and methods. Stratified screening with ultrasonography (US) + alpha-fetoprotein (AFP) quarterly for high-risk and annually for low-risk groups, and screening with quarterly alternating US + AFP/gadoxetic-enhanced magnetic resonance imaging for high-risk and six-monthly US + AFP for low-risk groups, are the most cost-effective under the 1 × and 3 × gross domestic product thresholds, respectively. Furthermore, reducing cell-free DNA testing costs would boost the optimal strategies’ probability advantage, even if re-stratification is required more frequently.
Citation	Zhang YB, Li YX, Zhang WD, Hou XB, Li R, Xia RY, Shen MW, Zou ZR, Zhuang GH. Cost-effectiveness of risk-stratified hepatocellular carcinoma screening using the age-male-albumin-bilirubin-platelets score-based stepwise enrichment approach in patients with cirrhosis. World J Gastroenterol 2026; In press DOI: https://doi.org/10.3748/wjg.121840
PDF	121840-in-press.pdf

Received	2026-04-03 03:39
Peer-Review Started	2026-04-03 03:41
First Decision by Editorial Office Director	2026-05-09 10:39
Return for Revision	2026-05-09 10:39
Revised	2026-05-23 09:26
Publication Fee Transferred	2026-05-25 09:27
Second Decision by Editor	2026-06-04 02:54
Second Decision by Editor-in-Chief
Final Decision by Editorial Office Director	2026-06-04 06:31
Articles in Press	2026-06-04 06:31
Edit the Manuscript by Language Editor
Typeset the Manuscript

ISSN	1007-9327 (print) and 2219-2840 (online)
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Copyright	©Author(s) (or their employer(s)) 2026. No commercial re-use. See Permissions. Published by Baishideng Publishing Group Inc.
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