[Cost of screening for hepatocarcinoma in patients with cirrhosis: a prospective study]. / Coste del cribado del hepatocarcinoma en pacientes cirróticos: un estudio prospectivo.

INTRODUCTION: Current clinical guidelines recommend biannual screening for hepatocarcinoma in cirrhotic patients; however, the cost of this preventive activity is unknown. OBJECTIVE: To determine the cost of ultrasound screening for hepatocarcinoma in patients with cirrhosis. PATIENTS AND METHOD: Data on patients diagnosed with liver cirrhosis in a population of 245,042 inhabitants were prospectively gathered. The screening tests performed and cases of hepatocarcinoma diagnosed during the annual follow-up were included in the analysis. The cost of these tests was calculated based on the tariffs paid by insurance companies for health coverage of civil servants. RESULTS: In 2009, there were 374 patients with cirrhosis; of these, 99 were aged > 80 years, with a performance status of >2 or associated comorbidities. During the annual follow-up, the remaining patients underwent a total of 602 visits (abdominal ultrasound, blood test), four contrast-enhanced computed tomography scans, nine magnetic resonance scans, two scintigraphies, four aspiration biopsies, four radiographs and six contrast ultrasound scans. In our environment, the total estimated cost of these procedures was 37,946 €, indicating that the cost of a screening program for hepatocellular carcinoma according to the above-mentioned selection criteria is 0.155 € per inhabitant/year. If only cirrhotic patients suitable for screening are included, the annual cost of screening is 138 € per patient. CONCLUSION: The cost of an ultrasound screening program for hepatocarcinoma is 0.155 € per inhabitant/year. These data should be taken into account when considering population-based screening programs.

Noninvasive assessment of liver fibrosis in Crohn's disease patients exposed to methotrexate.

BACKGROUND: Methotrexate is widely used to treat some inflammatory chronic disorders, though it is hampered by the risk of liver fibrosis. Many recommendations have been made to assess methotrexate-related hepatotoxicity, including liver biopsy. However, other noninvasive methods to assess liver fibrosis have been developed and could be implemented for patients treated with methotrexate. AIM: The aim of the study was to compare the prevalence of liver fibrosis by means of noninvasive methods [aspartate transaminase-to-platelet ratio index (APRI) Forns index, and transient elastography] in patients with Crohn's disease exposed or not to methotrexate, and to identify risk factors for liver fibrosis. METHODS: Prospective, cross-sectional study. All patients with Crohn's disease exposed to methotrexate were included and compared to an unselected cohort of outpatients with Crohn's disease never exposed to methotrexate. RESULTS: A total of 84 patients with Crohn's disease, 56 exposed to methotrexate, and 28 controls, were included. Significant liver fibrosis was found in 7% of methotrexate-exposed patients with Crohn's disease and 10% of controls as measured by transient elastography, and in 7% of controls as measured by the Forns index. No cases of liver fibrosis were detected by APRI. Only alcohol consumption, diabetes mellitus, and age were associated with significant liver fibrosis. CONCLUSIONS: Significant liver fibrosis is uncommon among patients with Crohn's disease, even among those exposed to methotrexate. The risk of liver fibrosis in Crohn's disease seems to depend on common risk factors for liver disease.

Coste del cribado del hepatocarcinoma en pacientes cirróticos: un estudio prospectivo / Cost of screening for hepatocarcinoma in patients with cirrhosis: a prospective study

Introducción Las guías clínicas actuales recomiendan realizar un cribado semestral del hepatocarcinoma en pacientes cirróticos; sin embargo, desconocemos el coste de esta actividad preventiva.ObjetivoConocer el coste del cribado ecográfico del hepatocarcinoma en pacientes cirróticos.Pacientes y métodoRecopilación prospectiva de pacientes diagnosticados de cirrosis hepática en una población de 245.042 habitantes; se contabilizaron las pruebas realizadas para el cribado y diagnóstico de hepatocarcinomas durante el seguimiento anual. El coste de estas pruebas se valoró según las tarifas que abonan las entidades aseguradoras para la cobertura sanitaria de los colectivos de funcionarios públicos.ResultadosDurante el 2009 se registraron 374 pacientes con cirrosis; de ellos, 99 tenían edad > 80 años, performance status > 2 o comorbilidades asociadas. Durante el seguimiento anual se realizaron a los pacientes restantes un total de 602 visitas (ecografía abdominal y analítica), 4 TC con contraste, 9 resonancias magnéticas, 2 gammagrafías, 4 punciones aspirativas, 4 radiografías y 6 ecografías con contraste. En nuestro medio, el coste total estimado de estas exploraciones fue de 37.946 €. Ello indica que el coste de un programa de cribado del hepatocarcinoma según los criterios de selección indicados anteriormente es de 0,155 € por habitante y año. Si se consideran sólo los cirróticos susceptibles de cribado, el coste anual del cribado es de 138 € por paciente.ConclusiónEl coste de un programa de cribado ecográfico del hepatocarcinoma es de 0,155 € por habitante y año. Estos datos deben tenerse en cuenta cuando se plantean programas de ámbito poblacional(AU)

Introduction Current clinical guidelines recommend biannual screening for hepatocarcinoma in cirrhotic patients; however, the cost of this preventive activity is unknown.ObjectiveTo determine the cost of ultrasound screening for hepatocarcinoma in patients with cirrhosis.Patients and methodData on patients diagnosed with liver cirrhosis in a population of 245,042 inhabitants were prospectively gathered. The screening tests performed and cases of hepatocarcinoma diagnosed during the annual follow-up were included in the analysis. The cost of these tests was calculated based on the tariffs paid by insurance companies for health coverage of civil servants.ResultsIn 2009, there were 374 patients with cirrhosis; of these, 99 were aged > 80 years, with a performance status of >2 or associated comorbidities. During the annual follow-up, the remaining patients underwent a total of 602 visits (abdominal ultrasound, blood test), four contrast-enhanced computed tomography scans, nine magnetic resonance scans, two scintigraphies, four aspiration biopsies, four radiographs and six contrast ultrasound scans. In our environment, the total estimated cost of these procedures was 37,946 €, indicating that the cost of a screening program for hepatocellular carcinoma according to the above-mentioned selection criteria is 0.155 € per inhabitant/year. If only cirrhotic patients suitable for screening are included, the annual cost of screening is 138 € per patient.ConclusionThe cost of an ultrasound screening program for hepatocarcinoma is 0.155 € per inhabitant/year. These data should be taken into account when considering population-based screening programs(AU)