Screening for non-alcoholic fatty liver disease in persons with type 2 diabetes in the U.S. is cost effective: A comprehensive economical analysis

Noureddin, Mazen; Jones, Msc Calum; Vilar‐Gomez, Eduardo; Alkhouri, Naim; Therapondos, George; Mantry, Parvez S.; Girgrah, Nigel; Mitchell, Eric; Shea, Kristen; Sussman, Norman; Fuchs, Michael; Diaz, Viviana Figueroa; Dinani, Amreen; Dieterich, Douglas T.; Rinella, Mary E.

doi:10.1016/s0168-8278(20)30783-2

Cited by 6 publications

(6 citation statements)

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“…A model study reported that the cost‐effectiveness was better at identifying the early stage of F2 and intervening in patients’ lifestyles with vibration‐controlled transient elastography than with the FIB‐4 index identifying advanced fibrosis and starting medications. ( 46 ) Identifying fibrosis stage F2 in the future may be important.…”

Section: Discussionmentioning

confidence: 99%

Type IV Collagen 7S Is the Most Accurate Test For Identifying Advanced Fibrosis in NAFLD With Type 2 Diabetes

Ishiba¹,

Sumida

Seko³

et al. 2020

Hepatol Commun

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This study aimed to examine whether the diagnostic accuracy of four noninvasive tests (NITs) for detecting advanced fibrosis in nonalcoholic fatty liver disease (NAFLD) is maintained or is inferior to with or without the presence of type 2 diabetes. Overall, 874 patients with biopsy‐proven NAFLD were enrolled. After propensity‐score matching by age, sex, and the prevalence of dyslipidemia, 311 patients were enrolled in each group of with or without diabetes. To evaluate the effect of diabetes, we compared the diagnostic accuracy of the fibrosis‐4 (FIB‐4) index, the NAFLD fibrosis score (NFS), the aspartate aminotransferase to platelet ratio index (APRI), and type IV collagen 7S (COL4‐7S) in patients with NAFLD with and without diabetes. The areas under the receiver operating characteristic curve (AUROC) for identifying advanced fibrosis in patients without diabetes were 0.879 for the FIB‐4 index, 0.851 for the NFS, 0.862 for the APRI, and 0.883 for COL4‐7S. The AUROCs in patients with diabetes were 0.790 for the FIB‐4 index, 0.784 for the NFS, 0.771 for the APRI, and 0.872 for COL4‐7S. The AUROC of COL4‐7S was significantly larger than that of the other NITs in patients with NAFLD with diabetes than in those without diabetes. The optimal high and low cutoff points of COL4‐7S were 5.9 ng/mL and 4.8 ng/mL, respectively. At the low cutoff point, the accuracy of COL4‐7S was better than that of the other NITs, especially in patients with diabetes. Conclusion: COL4‐7S measurement might be the best NIT for identifying advanced fibrosis in NAFLD, especially in NAFLD with diabetes.

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Section: Discussionmentioning

confidence: 99%

Type IV Collagen 7S Is the Most Accurate Test For Identifying Advanced Fibrosis in NAFLD With Type 2 Diabetes

Ishiba¹,

Sumida

Seko³

et al. 2020

Hepatol Commun

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“…A recent US study based on Markov modelling concluded that screening patients with T2DM for NAFLD was more cost-effective than no screening strategies. 82 The model assumed a cohort of patients aged 55 years followed across 1-year cycles. The most cost-effective screening approach was an ultrasound (with or without ALT) followed by a Fibroscan if there was evidence of NAFLD.…”

Section: Cost-effectivenessmentioning

confidence: 99%

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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“…In this study, we tried to compare the size of net benefits for hepatic fibrosis screening among known various high-risk groups in community cohorts. So far, a few social economic analyses were performed in selected high-risk populations (NAFLD cohort or diabetes cohort) with conflicting results [ 7 , 8 ], but a comprehensive net benefit analysis according to various high-risk groups in primary care settings has not been reported. We believe that the results of this study can be helpful in understanding the target population and priority of screening algorithms in various high-risk groups in primary care centers.…”

Section: Discussionmentioning

confidence: 99%

“…Meanwhile, despite the high prevalence of advanced fibrosis in patients with diabetes [ 3 , 5 , 6 ], consensus on the need for the screening of significant hepatic fibrosis in all diabetic patients is unclear, with a lack of evidence demonstrating benefit from screening. To the best of our knowledge, the cost-effectiveness of a screening strategy for NASH or advanced fibrosis in patients with diabetes has been evaluated in only two studies, which showed conflicting results [ 7 , 8 ]. Furthermore, in the screening strategies used in those studies, all patients first underwent ultrasonography (USG) to detect fatty liver.…”

Section: Introductionmentioning

confidence: 99%

Determining the Target Population That Would Most Benefit from Screening for Hepatic Fibrosis in a Primary Care Setting

et al. 2021

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Due to its high prevalence, screening for hepatic fibrosis in the low-risk population is called for action in the primary care clinic. However, current guidelines provide conflicting recommendations on populations to be screened. We aimed to identify the target populations that would most benefit from screening for hepatic fibrosis in clinical practice. This study examined 1288 subjects who underwent magnetic resonance elastography. The diagnostic performance of the Fibrosis-4 (FIB-4) index and NAFLD fibrosis score was compared in the following groups: (1) ultrasonography (USG)-diagnosed NAFLD, (2) elevated liver enzyme, (3) metabolic syndrome, (4) impaired fasting glucose, and (5) type 2 diabetes regardless of fatty liver. Decision curve analysis was performed to express the net benefit of groups over a range of probability thresholds (Pts). The diabetes group showed a better area under the receiver operating characteristic curve (AUROC: 0.69) compared with subjects in the USG-diagnosed NAFLD (AUROC: 0.57) and elevated liver enzyme (AUROC: 0.55) groups based on the FIB-4 index. In decision curve analysis, the diabetes group showed the highest net benefit for the detection of significant fibrosis across a wide range of Pts. Patients with diabetes, even in the absence of fatty liver, would be preferable for hepatic fibrosis screening in low-risk populations.

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Screening for non-alcoholic fatty liver disease in persons with type 2 diabetes in the U.S. is cost effective: A comprehensive economical analysis

Cited by 6 publications

References 0 publications

Type IV Collagen 7S Is the Most Accurate Test For Identifying Advanced Fibrosis in NAFLD With Type 2 Diabetes

Type IV Collagen 7S Is the Most Accurate Test For Identifying Advanced Fibrosis in NAFLD With Type 2 Diabetes

Case-finding strategies in non-alcoholic fatty liver disease

Determining the Target Population That Would Most Benefit from Screening for Hepatic Fibrosis in a Primary Care Setting

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