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Surveillance of hepatocellular carcinoma (HCC), via 6-monthly ultrasonography with alpha-fetoprotein testing, is currently recommended for patients with chronic liver disease at risk of HCC. Unlike other liver diseases where HCC occurs almost exclusively in patients with cirrhosis, up to 30% of hepatitis B virus (HBV)-associated HCC occurs in patients without cirrhosis.1 Thus, HCC surveillance is additionally recommended for individuals with non-cirrhotic chronic HBV on reaching a certain age, men >40 years and women >50 years in endemic countries, and as early as the third decade of life for individuals from Africa.2 This recommendation is based on a perceived 0.2% per year HCC incidence which was considered cost-effective for HCC surveillance.3 However, a more recent study found an HCC incidence of 0.4% per year to be cost-effective for surveillance at a higher willingness-to-pay level, with a major influence of surveillance adherence.4