Transient elastography for screening of liver fibrosis: Cost-effectiveness analysis from six prospective cohorts in Europe and Asia
Miquel Serra-Burriel1,†
, Isabel Graupera2,3,†
, Pere Torán4
, Maja Thiele5
, Dominique Roulot6,7
, Vincent Wai-Sun Wong8
, Indra Neil Guha9
, Núria Fabrellas10
, Anita Arslanow11,12
, Carmen Expósito4
, Rosario Hernández13
, Grace Lai-Hung Wong8
, David Harman9
, Sarwa Darwish Murad14
, Aleksander Krag5
, Guillem Pera4
, Paolo Angeli15
, Peter Galle11
, Guruprasad P. Aithal9
, Llorenç Caballeria4
, Laurent Castera16,17
, Pere Ginès2,3
, Frank Lammert12,low asterisk,'Correspondence information about the author Frank LammertEmail the author Frank Lammert
on behalf of the investigators of the LiverScreen Consortium
PlumX Metrics
DOI: https://doi.org/10.1016/j.jhep.2019.08.019 |
Highlights
•Optimal liver stiffness thresholds for community-based screening of at-risk patients are 9.1–9.5 kPa for fibrosis (stages ≥F2).
•Transient elastography is a cost-effective intervention for identifying patients with liver fibrosis in primary care.
•Between 2,500 to 6,500 PPP-adjusted euros are needed to gain an extra year of life, adjusted for quality of life.
•The survival effect of screening is most pronounced for the identification of significant (≥F2) fibrosis.
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 ± 12 years, BMI 27 ± 5 kg/m2, liver stiffness 5.6 ± 5.0 kPa). A 9.1 kPa TE cut-off provided the best accuracy for the diagnosis of significant fibrosis (≥F2) in general population settings, whereas a threshold of 9.5 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 ≥45 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.
Lay summary
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.
Keywords:
Alcohol-related liver disease, Liver fibrosis, Non-alcoholic fatty liver disease, Stratified screening, Transient elastography作者: StephenW 时间: 2019-11-16 18:42