The recommended threshold for HCC surveillance was largely based on an unpublished cost-effectiveness study from 1999 that reported HCC surveillance with biannual ultrasound and AFP in a cohort of hepatitis B carriers ≥ age 30 years with an annual HCC incidence ≥ 0.2% would prolong life by 3 months and would be cost-effective at a willingness to pay at $50,000/life year gained [6, 7]. Here, AFP is linked to hepatocellular carcinoma.