Cost-comparison analysis of FIB-4, ELF and fibroscan in community pathways for non-alcoholic fatty liver disease

Abstract

Background The identification of patients with advanced liver fibrosis secondary to non-alcoholic fatty liver disease (NAFLD) remains challenging. Using non-invasive liver fibrosis tests (NILT) in primary care may permit earlier detection of patients with clinically significant disease for specialist review, and reduce unnecessary referral of patients with mild disease. We constructed an analytical model to assess the clinical and cost differentials of such strategies. Methods A probabilistic decisional model simulated a cohort of 1000 NAFLD patients over 1 year from a healthcare payer perspective. Simulations compared standard care (SC) (scenario 1) to: Scenario 2: FIB-4 for all patients followed by Enhanced Liver Fibrosis (ELF) test for patients with indeterminate FIB-4 results; Scenario 3: FIB-4 followed by fibroscan for indeterminate FIB-4; Scenario 4: ELF alone; and Scenario 5: fibroscan alone. Model estimates were derived from the published literature. The primary outcome was cost per case of advanced fibrosis detected. Results Introduction of NILT increased detection of advanced fibrosis over 1 year by 114, 118, 129 and 137% compared to SC in scenarios 2, 3, 4 and 5 respectively with reduction in unnecessary referrals by 85, 78, 71 and 42% respectively. The cost per case of advanced fibrosis (METAVIR ≥F3) detected was £25,543, £8932, £9083, £9487 and £10,351 in scenarios 1, 2, 3, 4 and 5 respectively. Total budget spend was reduced by 25.2, 22.7, 15.1 and 4.0% in Scenarios 2, 3, 4 and 5 compared to £670 K at baseline. Conclusion Our analyses suggest that the use of NILT in primary care can increases early detection of advanced liver fibrosis and reduce unnecessary referral of patients with mild disease and is cost efficient. Adopting a two-tier approach improves resource utilization.

Systematic Literature Review and Critical Appraisal of Health Economic Models Used in Cost-Effectiveness Analyses in Non-Alcoholic Steatohepatitis: Potential for Improvements

“…A further two articles were identified through supplementary searches of grey literature. As such, a total of 19 articles [11,[16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] (capturing 16 different models) were included in the review; summary details of identified studies are shown in Table 1.…”

“…A total of 13 articles assessed health economic outcomes associated with different screening or diagnostic strategies [16,[18][19][20][21][26][27][28][29][30][31][32][33]; five assessed outcomes with different treatments, including lifestyle intervention, pioglitazone, vitamin E and obeticholic acid as well as bariatric surgery for overweight/obese patients with NASH [17,[22][23][24][25]. The remaining article examined the overall clinical and economic burden of disease and as such was a non-comparative study [11].…”

MANAGEMENT OF ENDOCRINE DISEASE: Non-alcoholic fatty liver disease: a multidisciplinary approach towards a cardiometabolic liver disease

“…Therefore, diagnostic decisions should be made individually based on the specific case, the available diagnostic tools and the potential harms and benefits of the different diagnostic tools. Table 1 shows an overview of the advantages and disadvantages of available diagnostic tools (49).…”

The Matrisome, Inflammation, and Liver Disease

“…7 An improvement in referral practices and noninvasive tests has increased the rate of early detection of asymptomatic chronic liver diseases. 68 This paradigm change opens up the opportunity for mechanism-based therapies to halt disease progression during earlier (i.e., prefibrotic) phases of the disease progression. Fig.…”