Screening for Nonalcoholic Fatty Liver Disease in Persons with Type 2 Diabetes in the United States Is Cost-effective: A Comprehensive Cost-Utility Analysis

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

doi:10.1053/j.gastro.2020.07.050

Cited by 96 publications

(100 citation statements)

References 19 publications

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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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“…39 Several cost-effectiveness analyses have shown that testing populations at risk for liver disease but with low prevalence of advanced fibrosis is cost-effective. 21,37,[40][41][42][43]44 The selection of a NIT in particular patients should be in accordance with the known indications and limitations of such tests (for instance avoid FibroTest TM in patients with Gilbert's or TE in patients with heart failure). It is therefore advisable that hepatologists are involved and consulted when NITs and pathways are designed and implemented in populations at risk outside secondary care.…”

Section: Recommendationsmentioning

confidence: 99%

EASL Clinical Practice Guidelines on non-invasive tests for evaluation of liver disease severity and prognosis – 2021 update

Berzigotti¹,

Tsochatzis²,

Boursier³

et al. 2021

Journal of Hepatology

1,018

615

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“…Because the cost effectiveness of screening in diabetic patients has been confirmed, 95 patients with diabetes should receive screening tests for NAFLD regardless of their liver enzyme levels.…”

Section: -1 Who Should Be Targeted For Nafld Screening and How Is Screening Conducted?mentioning

confidence: 99%

“…Screening for NAFLD should be considered in cases of persistent liver enzyme elevation. Because the cost effectiveness of screening in diabetic patients has been confirmed [ 95 ], patients with diabetes should receive screening tests for NAFLD regardless of their liver enzyme levels. In addition, subjects with metabolic syndrome (which is closely associated with insulin resistance), obesity, and other risk factors for NAFLD can be considered for screening tests [ 17 , 96 ].…”

Section: Diagnosismentioning

confidence: 99%

KASL clinical practice guidelines: Management of nonalcoholic fatty liver disease

Kang

Lee

Yoo³

et al. 2021

Clin Mol Hepatol

191

206

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Screening for Nonalcoholic Fatty Liver Disease in Persons with Type 2 Diabetes in the United States Is Cost-effective: A Comprehensive Cost-Utility Analysis

Cited by 96 publications

References 19 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

EASL Clinical Practice Guidelines on non-invasive tests for evaluation of liver disease severity and prognosis – 2021 update

KASL clinical practice guidelines: Management of nonalcoholic fatty liver disease

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