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World J Gastroenterol. 2017 May 7;23(17):3163-3173. doi: 10.3748/wjg.v23.i17.3163.

Cost-effectiveness of enhanced liver fibrosis test to assess liver fibrosis in chronic hepatitis C virus and alcoholic liver disease patients.

Author information

1
Marcelo Soto, Fundació Clínic per a la Recerca Biomèdica, 08036 Barcelona, Spain.

Abstract

AIM:

To assess liver fibrosis (LF) in hepatitis C virus (HCV) and alcoholic liver disease (ALD), estimate health outcomes and costs of new noninvasive testing strategies.

METHODS:

A Markov model was developed to simulate LF progression in HCV and ALD for a cohort of 40-year-old men with abnormal levels of transaminases. Three different testing alternatives were studied: a single liver biopsy; annual Enhanced liver fibrosis (ELF™) followed by liver stiffness measurement (LSM) imaging as a confirmation test if the ELF test is positive; and annual ELF test without LSM. The analysis was performed from the perspective of a university hospital in Spain. Clinical data were obtained from published literature. Costs were sourced from administrative databases of the hospital. Deterministic and probabilistic sensitivity analyses were performed.

RESULTS:

In HCV patients, annual sequential ELF test/LSM and annual ELF test alone prevented respectively 12.9 and 13.3 liver fibrosis-related deaths per 100 persons tested, compared to biopsy. The incremental cost-effectiveness ratios (ICERs) were respectively €13400 and €11500 per quality-adjusted life year (QALY). In ALD, fibrosis-related deaths decreased by 11.7 and 22.1 per 100 persons tested respectively with sequential ELF test/LSM and annual ELF test alone. ICERs were €280 and €190 per QALY, respectively.

CONCLUSION:

The use of the ELF test with or without a confirmation LSM are cost-effective options compared to a single liver biopsy for testing liver fibrosis in HCV and ALD patients in Spain.

KEYWORDS:

Alcoholic liver disease; Cost-effectiveness analysis; Hepatitis C; Liver fibrosis; Noninvasive diagnostic assessment

PMID:
28533673
PMCID:
PMC5423053
DOI:
10.3748/wjg.v23.i17.3163
[Indexed for MEDLINE]
Free PMC Article

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