Published online May 7, 2017. doi: 10.3748/wjg.v23.i17.3163
Peer-review started: November 21, 2016
First decision: December 28, 2016
Revised: March 3, 2017
Accepted: March 15, 2017
Article in press: March 15, 2017
Published online: May 7, 2017
To assess liver fibrosis (LF) in hepatitis C virus (HCV) and alcoholic liver disease (ALD), estimate health outcomes and costs of new noninvasive testing strategies
A Markov model was developed to simulate LF progression in HCV and ALD for a cohort of 40-year-old men with abnormal levels of transaminases. Three different testing alternatives were studied: a single liver biopsy; annual Enhanced liver fibrosis (ELF™) followed by liver stiffness measurement (LSM) imaging as a confirmation test if the ELF test is positive; and annual ELF test without LSM. The analysis was performed from the perspective of a university hospital in Spain. Clinical data were obtained from published literature. Costs were sourced from administrative databases of the hospital. Deterministic and probabilistic sensitivity analyses were performed.
In HCV patients, annual sequential ELF test/LSM and annual ELF test alone prevented respectively 12.9 and 13.3 liver fibrosis-related deaths per 100 persons tested, compared to biopsy. The incremental cost-effectiveness ratios (ICERs) were respectively €13400 and €11500 per quality-adjusted life year (QALY). In ALD, fibrosis-related deaths decreased by 11.7 and 22.1 per 100 persons tested respectively with sequential ELF test/LSM and annual ELF test alone. ICERs were €280 and €190 per QALY, respectively.
The use of the ELF test with or without a confirmation LSM are cost-effective options compared to a single liver biopsy for testing liver fibrosis in HCV and ALD patients in Spain.
Core tip: Noninvasive methods to diagnose liver fibrosis have been proposed as an alternative to liver biopsy in patients with abnormal level of transaminases. In a Markov model, sequential testing with enhanced liver fibrosis (ELF) test followed by liver stiffness measurement (LSM) significantly reduce liver-related lifetime morbidity and mortality, compared with biopsy, in hepatitis C virus (HCV) and alcoholic liver disease patients. Noninvasive methods are also associated with an increase in quality-adjusted life years and costs. Overall, they are cost-effective strategies compared with biopsy. ELF test with or without a confirmation LSM may represent a more affordable strategy than the “treat-all” option in HCV patients.