Cost-utility analysis of nonalcoholic steatohepatitis screening

Abstract

• This cost-utility analysis suggests that screening for nonalcoholic steatohepatitis may be cost-effective. • In particular, screening of high-risk obese or diabetic populations is more cost-effective. • Magnetic resonance elastography was more cost-effective to confirm disease compared to biopsy. • More studies are needed to determine quality of life in nonalcoholic steatohepatitis. • More management strategies for nonalcoholic steatohepatitis are also needed.

Non-alcoholic fatty liver disease and cardiovascular risk: Pathophysiological mechanisms and implications

“…Awareness of physicians for the presence of NASH and a correct interpretation of tests that are already performed would probably result in a considerably higher detection rate without any additional cost. Moreover, a Canadian cost-effectiveness study supports cost-effectiveness of non-invasive screening for NASH and advanced fibrosis in a high-risk obese or diabetic population [186].…”

Bariatric surgery for nonalcoholic steatohepatitis: A clinical and cost‐effectiveness analysis

“…(11) Due to a lack of data on the durability of NASH remission after surgery, we approximated NASH disease relapse from studies on diabetes relapse after bariatric surgery. (16,17) (25) CC to DC 5.8% 4% 16% (21,24,28) CC to death 2.09% 2% 4% (21,24,28) DC to death 13% 10% 38% (22) CC/DC to HCC 0.69% 0.50% 16.8% (,21-24) HCC to death 42.7% 33.0% 86.0% (30) Treatment efficacy estimates Surgery: probability of NASH remission at year 5 69.7% 30% 100% (11) Surgery: probability of NASH relapse (annual) 6.3% 5.1% 100% (16,17) ILI: probability of NASH remission at year 1 25% 20% 30% (47) ILI: probability of NASH relapse (annual) 17.7% 3.0% 27.0% (15) Health state quality-of-life values NASH F0 0.85 0.84 0.86 (48,49) NASH F1-F3 0.84 0.83 0.85 (48,49) CC 0.80 0.65 0.89 (50) DC 0.60 0.46 0.81 (50) HCC 0.73 0.50 0.80 (50) Obesity class quality-of-life values Overweight 0.88 0.73 1.00 (31) Class 1 obesity (30-34.99) 0.85 0.70 1.00 (31) Class 2 obesity (35-39.99) 0.82 0.68 0.96 (31) Class 3 obesity (40-44.99) 0.78 0.64 0.92 (31) *A brief overview of key model inputs as well as ranges used in one-way sensitivity analyses. Probabilities indicate annual transition probabilities unless otherwise indicated.…”

Diagnosis and Characterization of Non-Alcoholic Fatty Liver Disease

“…As a consequence of its high prevalence, especially in subjects with the abovementioned risk factors, its prognostic implications, and given that NAFLD is generally an asymptomatic disease, some authors recommend the implantation of an NAFLD-screening programme within the risk population [22,23]. However, this topic is at present controversial given the great load on the national health systems that could be caused by these screening programmes and the lack of efficacious treatments currently available.…”