Bolondi et al. evaluated the cost effectiveness of surveillance of hepatocellular carcinoma (HCC). A cohort of 313 Italian patients with cirrhosis was enrolled in an HCC surveillance program that consisted of ultrasonography (US) and serum -fetoprotein (AFP) performed every 6 mo. Hepatitis C was present in 64%, hepatitis B (17%), and alcohol abuse (25%). This cohort was compared to a control group of 104 consecutive patients referred from other facilities for incidentally detected HCC. The two main outcomes examined were eligibility of patients for treatment as well as survival. Additional outcomes were the overall cost of surveillance program; cost per treatable HCC; and cost per year of life saved. During a follow-up period averaging 56 months, 61 patients (20%) in the surveillance program developed HCC (incidence 4.1% year). Only 69% of patients with HCC were treated as follows: 9% had surgical resection, 26% liver transplantation, 24% percutaneous ethanol injection, and 43% had transarterial chemoembolization [TACE]. The cumulative survival rate of the patients with HCC detected in the surveillance program was significantly longer than that of the controls (p = 0.02). The median survival for patients with HCC in the surveillance and control groups was 30 and 15 months, respectively. Multivariate analysis showed surveillance to be an independent predictor of longer survival. Elevated AFP, Child-Pugh classes B and C, and male sex were found to be independent risk factors for developing HCC. The overall cost of the surveillance program was $753,226. The cost per treatable HCC was $17,934, and the cost for year of life saved was $112,993. The cost authors concluded that their HCC surveillance program in patients with cirrhosis consumed a large number of resources and offered little benefit in patient survival. (Am J Gastroenterol 2002;97:2676–2677. © 2002 by Am. Coll. of Gastroenterology)