Transient elastography for the diagnosis of liver fibrosis: a systematic review of economic evaluations

Katwyk, Sasha van; Coyle, Doug; Cooper, Curtis; Pussegoda, Kusala; Cameron, Chris; Skidmore, Becky; Brener, S; Moher, David; Thavorn, Kednapa

doi:10.1111/liv.13260

Cited by 31 publications

(20 citation statements)

References 21 publications

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“…TE could be less costly in countries with lower opportunity cost of public funds and in those where nurses perform the exams. Liver fibrosis staging by TE seems to be cost-effective compared to liver biopsy and it was priced from US$ 21 to US$ 73 in the United Kingdom and up to US$ 145 in the United States [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

“…Eradication of hepatitis C virus (HCV) has been associated with lower rates of liver-related complications [ 2 ]. Transient elastography (TE) by FibroScan® (EchoSens, Paris, France) is a validated method to liver fibrosis assessment [ 3 ] and seems to be cost-effective to diagnose cirrhosis compared to liver biopsy [ 4 ]. The high efficacy of direct-acting antiviral drugs (DAAs) has revolutionized the management of patients with CHC.…”

Section: Introductionmentioning

confidence: 99%

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Micro-costing analysis of guideline-based treatment by direct-acting agents: the real-life case of hepatitis C management in Brazil

et al. 2017

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BackgroundEradication of hepatitis C virus (HCV) using direct-acting agents (DAA) has been associated with a financial burden to health authorities worldwide. We aimed to evaluate the guideline-based treatment costs by DAAs from the perspective of the Brazilian Ministry of Health (BMoH).MethodsThe activity based costing method was used to estimate the cost for monitoring/treatment of genotype-1 (GT1) HCV patients by the following strategies: peg-interferon (PEG-IFN)/ribavirin (RBV) for 48 weeks, PEG-IFN/RBV plus boceprevir (BOC) or telaprevir (TEL) for 48 weeks, and sofosbuvir (SOF) plus daclastavir (DCV) or simeprevir (SIM) for 12 weeks. Costs were reported in United States Dollars without (US$) and with adjustment for purchasing power parity (PPP$). Drug costs were collected at the National Database of Health Prices and an overview of the literature was performed to assess effectiveness of SOF/DCV and SOF/SIM regimens in real-world cohorts.ResultsTreatment costs of GT1-HCV patients were PPP$ 43,176.28 (US$ 24,020.16) for PEG-IFN/RBV, PPP$ 71,196.03 (US$ 39,578.23) for PEG-IFN/RBV/BOC and PPP$ 86,250.33 (US$ 47,946.92) for PEG-IFN/RBV/TEL. Treatment by all-oral interferon-free regimens were the less expensive approach: PPP$ 19,761.72 (US$ 10,985.90) for SOF/DCV and PPP$ 21,590.91 (US$ 12,002.75) for SOF/SIM. The overview reported HCV eradication in up to 98% for SOF/DCV and 96% for SOF/SIM.ConclusionStrategies with all oral interferon-free might lead to lower costs for management of GT1-HCV patients compared to IFN-based regimens in Brazil. This occurred mainly because of high discounts over international DAA prices due to negotiation between BMoH and pharmaceutical industries.Electronic supplementary materialThe online version of this article (10.1186/s12876-017-0676-8) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Micro-costing analysis of guideline-based treatment by direct-acting agents: the real-life case of hepatitis C management in Brazil

et al. 2017

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“…Clinical trials showed that FibroScan results, which are expressed in kPa, reported similar results to that of METAVIR score during biopsy interpretation of liver fibrosis in patients with CHC [10]. Moreover, this procedure has also been validated in chronic hepatitis B, NAFLD, alcoholic liver disease, primary biliary cirrhosis, and primary sclerosing cholangitis [14,15]. However, this methodology also has some limitations such as feasibility and unreliability, particularly in obese patients or under the circumstances of limited operator experience [16].…”

Section: Diagnosis Of Liver Fibrosismentioning

confidence: 76%

Noninvasive Biomarkers for the Diagnosis of Liver Fibrosis and Cirrhosis

Rosique-Oramas¹,

Martínez-Castillo²,

Guzmán³

et al. 2019

Liver Cirrhosis - Debates and Current Challenges

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The clinical importance of monitoring liver fibrosis lies in the morbidity and mortality of the chronic liver diseases in relation to the stage and progression of fibrosis. Whether the fibrosis stabilizes or regresses depends on the specific treatment. Liver biopsy, the current standard for the diagnosis, has implicit limitations due to sampling heterogeneity. There are noninvasive imaging methods, such as transient elastography that measures the stiffness of the liver, but it has some limitations (feasibility and unreliability), particularly in obese patients. FibroTest is the most widely used noninvasive serological method worldwide which is efficacious in the extreme stages of fibrosis, but these methods cannot discern intermediate stages. Liver fibrosis is a dynamic response that involves multiple cellular and molecular events with an excessive deposit of extracellular matrix. Even though there is much information on the pathophysiology of fibrosis, that knowledge is still incomplete, greatly hindering the development of both an accurate treatment and a noninvasive diagnostic method with adequate sensitivity for all the stages of fibrosis. It is known that IGFBP participates in liver homeostasis, and thus these proteins can be used as serum biomarkers during the progression of liver fibrosis in chronic hepatitis C.

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“…A recent systematic review looking at the cost-effectiveness of FibroScan compared to liver biopsy showed that FibroScan is economically attractive, but does incur added cost of approximately $1250 to $2922[1]. Apart from the cost, the accessibility of FibroScan may be an issue in the primary health care and resource limited setting.…”

Section: Discussionmentioning

confidence: 99%

“…Chronic hepatitis C virus (HCV) and hepatitis B virus (HBV) are among the most common causes of liver fibrosis[1]. A determination of the degree of liver fibrosis in these patients is essential to guide management as well as for prognostication[2-6].…”

Section: Introductionmentioning

confidence: 99%

Use of aspartate aminotransferase to platelet ratio to reduce the need for FibroScan in the evaluation of liver fibrosis

Wong

Huynh

Zhang

2017

WJH

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AIMTo evaluate the performance of aspartate aminotransferase to platelet ratio (APRI) score against FibroScan in predicting the presence of fibrosis.METHODSData of patients who concurrently had APRI score, FibroScan and liver biopsy to assess their hepatitis C virus (HCV) and hepatitis B virus (HBV) over 6 years were retrospectively reviewed and details of their disease characteristics and demographics were recorded. Advanced fibrosis was defined as ≥ F3.RESULTSOf the 3619 patients (47.5 ± 11.3 years, 97M:36F) who had FibroScans and APRI for HCV and HBV, 133 had concurrent liver biopsy. Advanced liver fibrosis was found in 27/133 (20%, F3 = 21 and F4 = 6) patients. Although APRI score (P < 0.001, AUC = 0.83) and FibroScan (P < 0.001, AUC = 0.84) predicted the presence of advanced fibrosis, the sensitivities and specificities were only modest (APRI score: 51.9% sensitivity, 84.9% specificity; FibroScan: 63% sensitivity, 84% specificity). Whilst 13/27 (48%) patients with advanced fibrosis had APRI ≤ 1.0, no patients with APRI ≤ 0.5 had advanced fibrosis, with 100% sensitivity. The use of APRI ≤ 0.5 would avoid the need for FibroScan in 43% of patients.CONCLUSIONAPRI score and FibroScan performed equally well in predicting advanced fibrosis. A proposed APRI cut-off score of 0.5 could be used as a screening tool for FibroScan, as cut-off score of 1.0 will miss up to 48% of patients with advanced fibrosis. Further prospective validation studies are required to confirm this finding.

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Transient elastography for the diagnosis of liver fibrosis: a systematic review of economic evaluations

Abstract: Transient elastography is an economically attractive alternative to liver biopsy and other non-invasive diagnostic tests especially for patients with a higher degree of liver fibrosis.

Cited by 31 publications

References 21 publications

Micro-costing analysis of guideline-based treatment by direct-acting agents: the real-life case of hepatitis C management in Brazil

Micro-costing analysis of guideline-based treatment by direct-acting agents: the real-life case of hepatitis C management in Brazil

Noninvasive Biomarkers for the Diagnosis of Liver Fibrosis and Cirrhosis

Use of aspartate aminotransferase to platelet ratio to reduce the need for FibroScan in the evaluation of liver fibrosis

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