MOENA
Modeling interventions to prevent hepatocellular carcinoma related to harmful alcohol use
Primary Objective:To model the progression of individuals at risk of developing cirrhosis due to harmful alcohol use, focusing on effectiveness and cost-effectiveness. The aim is to predict the impact of various interventions on the incidence of cirrhosis and hepatocellular carcinoma (HCC) in France.
Secondary Objective:To evaluate the impact of healthcare interventions, such as early detection of HCC and therapeutic management, on the survival of patients with alcohol-related cirrhosis in France.
Project period
-
Main investigator
Abbas MOURAD
SESSTIM member(s) of the project:
Sponsors:
Institut National du Cancer (INCa)
Research topics:
Research question:
In France, the consequences of harmful alcohol consumption represent a major public health issue, as it was the cause of 41,000 deaths in 2019. It is the 2nd cause of lifestyle-related cancer after tobacco. It considered responsible for at least 37% of cases of hepatocellular carcinoma (HCC). The annual incidence of HCC in people with alcohol-related cirrhosis is approximately 2.9%. Cessation or reduction of alcohol consumption may decrease the risk of developing liver cirrhosis, which may in turn decrease the risk of HCC if alcohol consumption is reduced by 6-7%/year.
Method:
A gender-stratified Markov mathematical model will simulate the progression of the disease among individuals at risk of cirrhosis due to harmful alcohol use. Over time (cycle = 1 year), these individuals will transition from one state to another based on prevention and care interventions and/or their health status.
The model will be informed by various types of data, enabling us to identify and promote the most effective strategies for reducing the incidence of cirrhosis and hepatocellular carcinoma (HCC) and improving the survival of patients with HCC.
The work in this project is divided into three phases:
Phase 1: Develop a Markov Decision Model.
Phase 2: Validate the model's predictions using epidemiological data and findings from the scientific literature.
Phase 3: Test the impact of different intervention scenarios, particularly regarding the identification of harmful alcohol use, the reduction of alcohol consumption, and the increase in HCC screening rates
Research prospects:
The modeling in this study will allow for the prediction, on the one hand, of the progression of patients with harmful alcohol consumption under current practices, and on the other hand, their hypothetical progression under various intervention strategies and recommendations from the French Association for the Study of the Liver (AFEF) for the prevention of cirrhosis and HCC, as well as screening.
The results of the modeling of individuals with harmful alcohol consumption will enable the promotion of the best and most cost-effective strategies to reduce the incidence of cirrhosis and HCC.
The proposed model is a first step toward integrating prevention interventions that could significantly reduce the risk of liver cancer. This model could be further enhanced by incorporating additional interventions (such as the alcohol tax implemented in the United Kingdom) as well as different modalities for implementing the proposed interventions (e.g., compensating general practitioners for prevention activities).
