Cost-utility analysis of nonalcoholic steatohepatitis screening.
Eur Radiol
; 25(11): 3282-94, 2015 Nov.
Article
em En
| MEDLINE
| ID: mdl-25994191
ABSTRACT
OBJECTIVES:
Nonalcoholic fatty liver disease (NAFLD) is the most common liver disease in Western countries. No studies have examined the cost-effectiveness of screening its advanced form, nonalcoholic steatohepatitis (NASH).METHODS:
We performed a cost-utility analysis of annual noninvasive screening strategies using third-party payer perspective in a general population in comparison to screening a high-risk obese or diabetic population. Screening algorithms involved well-studied techniques, including NAFLD fibrosis score, transient elastography (TE), and acoustic radiation force impulse (ARFI) imaging for detecting advanced fibrosis (≥ F3); and plasma cytokeratin (CK)-18 for NASH detection. Liver biopsy and magnetic resonance elastography (MRE) were compared as confirmation methods. Canadian dollar (CAD or C$) costs were adjusted for inflation and discounted at 5%. Incremental cost-effectiveness ratio (ICER) of ≤C$ 50,000 was considered cost-effective.RESULTS:
Compared with no screening, screening with NAFLD fibrosis score/TE/CK-18 algorithm with MRE as confirmation for advanced fibrosis had an ICER of C$ 26,143 per quality-adjusted life year (QALY) gained. Screening in high-risk obese or diabetic populations was more cost-effective, with an ICER of C$ 9,051 and C$ 7,991 per quality-adjusted life-year (QALY) gained, respectively. Liver biopsy confirmation was not found to be cost-effective.CONCLUSIONS:
Our model suggests that annual NASH screening in high-risk obese or diabetic populations can be cost-effective. KEY POINTS ⢠This cost-utility analysis suggests that screening for nonalcoholic steatohepatitis may be cost-effective. ⢠In particular, screening of high-risk obese or diabetic populations is more cost-effective. ⢠Magnetic resonance elastography was more cost-effective to confirm disease compared to biopsy. ⢠More studies are needed to determine quality of life in nonalcoholic steatohepatitis. ⢠More management strategies for nonalcoholic steatohepatitis are also needed.Palavras-chave
Texto completo:
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Temas:
ECOS
/
Aspectos_gerais
/
Financiamentos_gastos
Bases de dados:
MEDLINE
Assunto principal:
Hepatopatia Gordurosa não Alcoólica
Tipo de estudo:
Diagnostic_studies
/
Etiology_studies
/
Health_economic_evaluation
/
Prognostic_studies
/
Risk_factors_studies
/
Screening_studies
Aspecto:
Patient_preference
Limite:
Humans
/
Middle aged
País/Região como assunto:
America do norte
Idioma:
En
Revista:
Eur Radiol
Assunto da revista:
RADIOLOGIA
Ano de publicação:
2015
Tipo de documento:
Article
País de afiliação:
Canadá