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Cost‐effectiveness of HCC surveillance among HCV patients after sustained virological response with direct‐acting antivirals

We read with interest the study "Hepatocellular carcinoma risk in hepatitis C stage-3 fibrosis after sustained virological response with direct-acting antivirals" by Dr Sánchez-Azofra and colleagues (1). The authors studied 506 hepatitis C virus (HCV) patients with sustained virological response (SVR) after direct-acting antivirals, all included patients had stage 3 fibrosis. Dr Sánchez-Azofra and colleagues found that the annual incidence of primary liver tumors in this cohort was 0.47%. Based on these findings, the authors concluded that the incidence of primary liver tumors among F3 fibrosis patients with HCV who had achieved SVR was lower than the 1.5% annual cut-off considered cost effective for hepatocellular carcinoma (HCC) surveillance (2). We congratulate the authors on studying this clinically relevant topic. However, we have several concerns regarding their conclusions.