Cost Effectiveness of Different Strategies for Detecting Cirrhosis in Patients With Nonalcoholic Fatty Liver Disease Based on United States Health Care System

Vilar‐Gomez, Eduardo; Lou, Zhouyang; Kong, Nan; Vuppalanchi, Raj; Imperiale, Thomas F.; Chalasani, Naga

doi:10.1016/j.cgh.2020.04.017

Cited by 48 publications

(29 citation statements)

References 28 publications

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“…The NICE analysis was criticized because of the unrealistically high diagnostic accuracy of the ELF test it used (sensitivity of 100% and specificity of 98%). Finally, a decision model to quantify the accuracy and costs of non-invasive strategies to detect cirrhosis in NAFLD, concluded that the J o u r n a l P r e -p r o o f combination of FIB4 and TE had the lowest cost and highest accuracy, followed by the combination of FIB4 and MRE and outperformed liver biopsy or any NIT alone [79].…”

Section: Cost-effectivenessmentioning

confidence: 99%

“…Finally, a decision model to quantify the accuracy and costs of non-invasive strategies to detect cirrhosis in NAFLD concluded that the combination of FIB-4 and TE had the lowest cost and highest accuracy, followed by the combination of FIB-4 and magnetic resonance elastography, both of which outperformed liver biopsy or any NIT alone. 79 …”

Section: Cost-effectivenessmentioning

confidence: 99%

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Case-finding strategies in non-alcoholic fatty liver disease

Boursier

Tsochatzis

2021

JHEP Reports

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Summary Among the large population of patients with non-alcoholic fatty liver disease (NAFLD), identifying those with advanced disease remains challenging. Many patients are diagnosed late, following the development of liver-related complications, leading to poor clinical outcomes. Accumulating evidence suggests that using non-invasive tests for liver fibrosis in patients with metabolic risk factors improves the detection of patients in need of specialised management and is cost-effective. Because of the vast number of patients requiring evaluation, the active participation of general practitioners and physicians who manage patients with metabolic disorders, such as diabetologists, is crucial; this calls for the increased awareness of NAFLD beyond liver clinics. Non-invasive case-finding strategies will need to be further validated and generalised for upcoming drug therapies to have the required impact on the worldwide burden of NAFLD.

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Section: Cost-effectivenessmentioning

confidence: 99%

Section: Cost-effectivenessmentioning

confidence: 99%

Case-finding strategies in non-alcoholic fatty liver disease

Boursier

Tsochatzis

2021

JHEP Reports

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“…In our analysis, we have chosen an endpoint of cost per correct diagnosis as a pragmatic way to economically evaluate each screening strategy [ 35 ]. Standard practice for patients in the community with NAFLD thought to be at increased risk of advanced fibrosis would be referral to a specialist for evaluation and confirmation of this diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Modelling the cost effectiveness of non-alcoholic fatty liver disease risk stratification strategies in the community setting

2021

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Background Non-alcoholic fatty liver disease (NAFLD) is highly prevalent worldwide. Identifying high-risk patients is critical to best utilize limited health care resources. We established a community-based care pathway using 2D ultrasound shear wave elastography (SWE) to identify high risk patients with NAFLD. Our objective was to assess the cost-effectiveness of various non-invasive strategies to correctly identify high-risk patients. Methods A decision-analytic model was created using a payer’s perspective for a hypothetical patient with NAFLD. FIB-4 [≥1.3], NAFLD fibrosis score (NFS) [≥-1.455], SWE [≥8 kPa], transient elastography (TE) [≥8 kPa], and sequential strategies with FIB-4 or NFS followed by either SWE or TE were compared to identify patients with either significant (≥F2) or advanced fibrosis (≥F3). Model inputs were obtained from local data and published literature. The cost/correct diagnosis of advanced NAFLD was obtained and univariate sensitivity analysis was performed. Results For ≥F2 fibrosis, FIB-4/SWE cost $148.75/correct diagnosis while SWE cost $276.42/correct diagnosis, identifying 84% of patients correctly. For ≥F3 fibrosis, using FIB-4/SWE correctly identified 92% of diagnoses and dominated all other strategies. The ranking of strategies was unchanged when stratified by normal or abnormal ALT. For ≥F3 fibrosis, the cost/correct diagnosis was less in the normal ALT group. Conclusions SWE based strategies were the most cost effective for diagnosing ≥F2 fibrosis. For ≥F3 fibrosis, FIB-4 followed by SWE was the most effective and least costly strategy. Further evaluation of the timing of repeating non-invasive strategies are required to enhance the cost-effective management of NAFLD.

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“…A recent study showed that FIB‐4 followed by VCTE is likely the most cost‐effective strategy for screening or detecting cirrhosis among patients with NAFLD in primary care clinics when compared to FIB‐4 followed by magnetic resonance elastography or liver biopsy, proving that a sequential strategy with FIB‐4 and VCTE may be a valid option to risk stratify these patients. ( 72 )…”

Section: Risk Stratification By Pcpmentioning

confidence: 99%

“…A recent study showed that FIB-4 followed by VCTE is likely the most cost-effective strategy for screening or detecting cirrhosis among patients with NAFLD in primary care clinics when compared to FIB-4 followed by magnetic resonance elastography or liver biopsy, proving that a sequential strategy with FIB-4 and VCTE may be a valid option to risk stratify these patients. (72) The introduction of a patient navigator into the care system of patients with chronic liver diseases (73) or patients with diabetes (74,75) has shown an improvement in care and glycemic control and better patient engagement. We believe that the integration of a patient navigator who comanages the checklist with the PCP would also greatly improve the screening rates as well as the rates of patients following up with subsequent testing and liver specialist services if needed.…”

Section: How To Screen? Integration Of Screening For Nash With Advancmentioning

confidence: 99%

Nonalcoholic Fatty Liver Disease Screening in Type 2 Diabetes Mellitus Patients in the Primary Care Setting

Barbosa

Lai

2021

Hepatology Communications

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Nonalcoholic fatty liver disease (NAFLD) is a major public health problem worldwide and the most common chronic liver disease. NAFLD currently affects approximately one in every four people in the United States, and its global burden is expected to rise in the next decades. Despite being a prevalent disease in the general population, only a minority of patients with NAFLD will develop nonalcoholic steatohepatitis (NASH) with advanced liver fibrosis (stage 3‐4 fibrosis) and liver‐related complications. Certain populations, such as patients with type 2 diabetes mellitus (T2DM), are recognized to be at the highest risk for developing NASH and advanced fibrosis. Both the American Diabetes Association and the European Association for the Study of Diabetes recommend screening of all T2DM for NAFLD. Incorporating a simple noninvasive algorithm into the existing diabetic care checklists in the primary care practice or diabetologist’s office would efficiently identify patients at high risk who should be referred to specialists. The proposed algorithm involves a first‐step annual fibrosis‐4 score (FIB‐4) followed by vibration‐controlled transient elastography (VCTE) for those with indeterminate or high‐risk score (FIB‐4 ≥1.3). Patients at low‐risk (FIB‐4 <1.3 or VCTE <8 kPa) can be followed up by primary care providers for lifestyle changes and yearly calculation of FIB‐4, while patients at high risk (FIB‐4 ≥1.3 and VCTE ≥8 kPa) should be referred to a liver‐specialized center. Conclusion: Patients with T2DM or prediabetes should be screened for NASH and advanced fibrosis. The proposed simple algorithm can be easily incorporated into the existing workflow in the primary care or diabetology clinic to identify patients at high risk for NASH and advanced fibrosis who should be referred to liver specialists.

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Cost Effectiveness of Different Strategies for Detecting Cirrhosis in Patients With Nonalcoholic Fatty Liver Disease Based on United States Health Care System

Cited by 48 publications

References 28 publications

Case-finding strategies in non-alcoholic fatty liver disease

Case-finding strategies in non-alcoholic fatty liver disease

Modelling the cost effectiveness of non-alcoholic fatty liver disease risk stratification strategies in the community setting

Nonalcoholic Fatty Liver Disease Screening in Type 2 Diabetes Mellitus Patients in the Primary Care Setting

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