The current study found at a willingness to pay at $100,000/QALY, HCC surveillance with biannual liver ultrasound and AFP in adults with CHB would not be cost-effective at a willingness to pay at $100,000/QALY unless the annual HCC risk is ≥ 0.55% which is 2.75 times higher than the threshold which was reported by Collier and adopted by AASLD. Here, AFP is linked to hepatocellular carcinoma.