The cost of detecting one case of HCC using determination of AST, ZTT, serum AFP and its glycoforms without ultrasound examination before screening the super high-risk population in this study was calculated to be $28,790. The presumptive cost calculated for the ultrasound mass screening including the two diagnosed HCC cases (without referring to the results of AFP L-3 and AFP P-4) was $1,241,950; a cost per case of $620,975. The authors pointed out that, although the detection rate in this study was comparable to the gold standard by the ultrasound-based screening method, false negative cases of HCC were not accounted for and an additional (50%) cases of early HCC might have been present.