Transient elastography for screening of liver fibrosis: Cost-effectiveness analysis from six prospective cohorts in Europe and Asia.
J Hepatol
; 71(6): 1141-1151, 2019 12.
Article
em En
| MEDLINE
| ID: mdl-31470067
ABSTRACT
BACKGROUND & AIMS:
Non-alcoholic fatty liver disease and alcohol-related liver disease pose an important challenge to current clinical healthcare pathways because of the large number of at-risk patients. Therefore, we aimed to explore the cost-effectiveness of transient elastography (TE) as a screening method to detect liver fibrosis in a primary care pathway.METHODS:
Cost-effectiveness analysis was performed using real-life individual patient data from 6 independent prospective cohorts (5 from Europe and 1 from Asia). A diagnostic algorithm with conditional inference trees was developed to explore the relationships between liver stiffness, socio-demographics, comorbidities, and hepatic fibrosis, the latter assessed by fibrosis scores (FIB-4, NFS) and liver biopsies in a subset of 352 patients. We compared the incremental cost-effectiveness of a screening strategy against standard of care alongside the numbers needed to screen to diagnose a patient with fibrosis stage ≥F2.RESULTS:
The data set encompassed 6,295 participants (mean age 55⯱â¯12â¯years, BMI 27⯱â¯5â¯kg/m2, liver stiffness 5.6⯱â¯5.0â¯kPa). A 9.1â¯kPa TE cut-off provided the best accuracy for the diagnosis of significant fibrosis (≥F2) in general population settings, whereas a threshold of 9.5â¯kPa was optimal for populations at-risk of alcohol-related liver disease. TE with the proposed cut-offs outperformed fibrosis scores in terms of accuracy. Screening with TE was cost-effective with mean incremental cost-effectiveness ratios ranging from 2,570 /QALY (95% CI 2,456-2,683) for a population at-risk of alcohol-related liver disease (age ≥45â¯years) to 6,217 /QALY (95% CI 5,832-6,601) in the general population. Overall, there was a 12% chance of TE screening being cost saving across countries and populations.CONCLUSIONS:
Screening for liver fibrosis with TE in primary care is a cost-effective intervention for European and Asian populations and may even be cost saving. LAYSUMMARY:
The lack of optimized public health screening strategies for the detection of liver fibrosis in adults without known liver disease presents a major healthcare challenge. Analyses from 6 independent international cohorts, with transient elastography measurements, show that a community-based risk-stratification strategy for alcohol-related and non-alcoholic fatty liver diseases is cost-effective and potentially cost saving for our healthcare systems, as it leads to earlier identification of patients.Palavras-chave
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Atenção Primária à Saúde
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Programas de Rastreamento
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Técnicas de Imagem por Elasticidade
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Hepatopatia Gordurosa não Alcoólica
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Cirrose Hepática
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Hepatopatias Alcoólicas
Tipo de estudo:
Diagnostic_studies
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Etiology_studies
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Guideline
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Health_economic_evaluation
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Prognostic_studies
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Risk_factors_studies
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Screening_studies
Limite:
Female
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Humans
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Male
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Middle aged
País como assunto:
Asia
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Europa
Idioma:
En
Ano de publicação:
2019
Tipo de documento:
Article