瞬态弹性成像技术筛查肝纤维化：欧洲和亚洲六个潜在人群

StephenW

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

StephenW

瞬态弹性成像技术筛查肝纤维化：欧洲和亚洲六个潜在人群的成本-效果分析
Miquel Serra-Burriel1，†
，伊莎贝尔·格劳佩拉2,3，†
，佩雷托兰4
，玛雅·蒂勒5
，多米尼克·罗洛（Dominique Roulot）6,7
，黄伟善8
，因陀罗·尼尔·古哈（Indra Neil Guha）9
，努里亚Fabrellas10
，阿妮塔·阿斯拉诺（Anita Arslanow）11,12
，卡门Expósito4
罗萨里奥·埃尔南德斯（RosarioHernández）13
，黄丽红8
戴维·哈曼（David Harman）9
，萨瓦（Sarwa）Darwish Murad14
，亚历山大·克拉格5
，吉列姆·佩拉4
保罗·安吉里15
彼得·加勒（Peter Galle）11
，古鲁普拉萨德·阿萨尔（9）
，LlorençCaballeria4
，劳伦·卡斯特拉16,17
，佩雷吉尼斯2,3
，Frank Lammert12，low asterisk，'有关作者Frank Lammert的通讯信息通过电子邮件发送给作者Frank Lammert
代表利物浦银幕财团的研究人员
PlumX指标
DOI：https：//doi.org/10.1016/j.jhep.2019.08.019 |

强调

    •社区筛查高危患者的最佳肝硬度阈值为9.1–9.5 kPa纤维化（≥F2期）。
    •瞬时弹性成像是一种经济有效的干预措施，可用于在初级保健中识别出肝纤维化患者。
    •需要PPP调整后的2500到6500欧元之间，以获得额外的寿命，并根据生活质量进行调整。
    •筛查的存活率对于识别显着（≥F2）的纤维化最为明显。

背景与目标

非酒精性脂肪肝和酒精相关性肝病由于存在大量高风险患者，因此对当前的临床医疗保健路径提出了重要挑战。因此，我们旨在探讨瞬时弹性成像（TE）作为在初级保健途径中检测肝纤维化的筛查方法的成本效益。
方法

使用来自6个独立的预期队列（来自欧洲的5个来自亚洲的1个）的真实个体患者数据进行了成本效益分析。开发了一种带有条件推理树的诊断算法，以探讨肝脏僵硬，社会人口统计学，合并症和肝纤维化之间的关系，后者由352名患者的肝纤维化评分（FIB-4，NFS）和肝活检评估。我们将筛查策略相对于护理标准的增量成本效益与筛查诊断纤维化≥F2期患者所需筛查的数字进行了比较。
结果

该数据集包括6,295名参与者（平均年龄55岁±12岁，BMI 27岁±5岁kg / m2，肝硬度5.6±5.0岁kPa）。 9.1 kPa TE临界值在一般人群中诊断严重纤维化（≥F2）的准确性最高，而对于酒精相关肝病高危人群，阈值9.5 kPa是最佳选择。就准确率而言，具有建议的临界值的TE优于纤维化评分。 TE筛查具有成本效益，对于酒精相关肝病高危人群（年龄≥45岁），平均增量成本效益比范围从2,570€/ QALY（95％CI 2,456–2,683）到6,217€/ QALY（95％CI 5,832-6,601）在一般人群中。总体而言，在国家和人群之间节省TE筛查的机会为12％。
结论

在欧洲和亚洲人群中，在初级保健中使用TE筛查肝纤维化是一种具有成本效益的干预措施，甚至可以节省成本。
放置摘要

在没有已知肝病的成年人中，缺乏用于检测肝纤维化的最佳公共卫生筛查策略，这对医疗保健构成了重大挑战。对来自6个独立国际队列的分析以及瞬时弹性成像测量结果表明，针对酒精相关和非酒精性脂肪肝疾病的基于社区的风险分层策略具有成本效益，并且对于我们的医疗系统而言可能节省成本，因为这导致早期识别患者。
关键字：
酒精相关肝病，肝纤维化，非酒精性脂肪肝病，分层筛查，瞬时弹性成像

neilhbver

国内医院可以做这个肝脏弹性测试