Transient elastography for screening of liver fibrosis: cost-effectiveness analysis from six prospective cohorts in Europe and Asia

Serra Burriel, Miquel; Graupera, Isabel; Toran, Pere; Thiele, Maja; Roulot, Dominique; Wai-Sun Wong, Vincent; Neil Guha, Indra; Fabrellas, Núria; Arslanow, Anita; Expósito, Carmen; Hernández, Rosario; Lai-Hung Wong, Grace; Harman, David; Darwish Murad, Sarwa; Krag, Aleksander; Pera, Guillem; Angeli, Paolo; Galle, Peter; Aithal, Guruprasad; Caballería Rovira, Llorenç; Castera, Laurent; Ginès, Pere; Lammert, Frank

Transient elastography for screening of liver fibrosis: cost-effectiveness analysis from six prospective cohorts in Europe and Asia

Mostra el registre complet Registre parcial de l'ítem

dc.contributor.author Serra Burriel, Miquel
dc.contributor.author Graupera, Isabel
dc.contributor.author Toran, Pere
dc.contributor.author Thiele, Maja
dc.contributor.author Roulot, Dominique
dc.contributor.author Wai-Sun Wong, Vincent
dc.contributor.author Neil Guha, Indra
dc.contributor.author Fabrellas, Núria
dc.contributor.author Arslanow, Anita
dc.contributor.author Expósito, Carmen
dc.contributor.author Hernández, Rosario
dc.contributor.author Lai-Hung Wong, Grace
dc.contributor.author Harman, David
dc.contributor.author Darwish Murad, Sarwa
dc.contributor.author Krag, Aleksander
dc.contributor.author Pera, Guillem
dc.contributor.author Angeli, Paolo
dc.contributor.author Galle, Peter
dc.contributor.author Aithal, Guruprasad
dc.contributor.author Caballería Rovira, Llorenç
dc.contributor.author Castera, Laurent
dc.contributor.author Ginès, Pere
dc.contributor.author Lammert, Frank
dc.date.accessioned 2021-03-01T09:09:44Z
dc.date.available 2021-03-01T09:09:44Z
dc.date.issued 2019
dc.description.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 ± 12 years, BMI 27 ± 5 kg/m 2, 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.en
dc.format.mimetype application/pdf
dc.identifier.citation Serra-Burriel M, Graupera I, Torán P, et al. Transient elastography for screening of liver fibrosis: cost-effectiveness analysis from six prospective cohorts in Europe and Asia. J. Hepatol. 2019 Dec;71(6):1141–51. DOI: 10.1016/j.jhep.2019.08.019
dc.identifier.doi http://dx.doi.org/10.1016/j.jhep.2019.08.019
dc.identifier.issn 0168-8278
dc.identifier.uri http://hdl.handle.net/10230/46634
dc.language.iso eng
dc.publisher Elsevier
dc.relation.ispartof Journal of hepatology. 2019 Dec;71(6):1141–51
dc.rights.accessRights info:eu-repo/semantics/embargoedAccess
dc.subject.keyword Alcohol-related liver diseaseen
dc.subject.keyword Liver fibrosisen
dc.subject.keyword Non-alcoholic fatty liver diseaseen
dc.subject.keyword Stratified screeningen
dc.subject.keyword Transient elastographyen
dc.title Transient elastography for screening of liver fibrosis: cost-effectiveness analysis from six prospective cohorts in Europe and Asiaen
dc.type info:eu-repo/semantics/article
dc.type.version info:eu-repo/semantics/acceptedVersion

Col·leccions

Articles (Departament d'Economia)