Acoustic Radiation Force Impulse Elastography for fibrosis evaluation in patients with chronic hepatitis C: An international multicenter study

Sporea, Ioan; Bota, Simona; Peck‐Radosavljevic, Markus; Şirli, Roxana; Tanaka, Hironori; Iijima, Hiroko; Badea, Radu; Lupşor, M.; Fierbinţeanu-Braticevici, Carmen; Petrişor, Ana; Saito, Hidetsugu; Ebinuma, Hirotoshi; Friedrich‐Rust, Mireen; Sarrazin, Christoph; Takahashi, Kazuhiro; Ono, Naofumi; Piscaglia, Fabio; Borghi, Alberto; D’Onofrio, Mirko; Gallotti, Anna; Ferlitsch, Arnulf; Popescu, Alina; Dănilă, Mirela

doi:10.1016/j.ejrad.2012.08.018

Cited by 163 publications

(114 citation statements)

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“…Studies that were judged as low risk of bias or unknown in the three most important QUADAS domains, namely patient selection, index test and reference standard, were still a modest fraction of the total number of studies (29 out of 152; 19%). 72,73,79,80,86,91,92,106,110,133,135,143,148,165,167,173,[197][198][199]201,203,[206][207][208]211,214,215,221,222 We explored potential sources of heterogeneity as outlined in the methods section. As all but five studies were of low methodological quality, 86,127,143,186,222 this potential source of heterogeneity could not be assessed.…”

Section: Results: Hepatitis C Virusmentioning

confidence: 99%

Cost-effectiveness of non-invasive methods for assessment and monitoring of liver fibrosis and cirrhosis in patients with chronic liver disease: systematic review and economic evaluation

Crossan

Tsochatzis

Longworth

et al. 2015

Health Technology Assessment

147

190

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BackgroundLiver biopsy is the reference standard for diagnosing the extent of fibrosis in chronic liver disease; however, it is invasive, with the potential for serious complications. Alternatives to biopsy include non-invasive liver tests (NILTs); however, the cost-effectiveness of these needs to be established.ObjectiveTo assess the diagnostic accuracy and cost-effectiveness of NILTs in patients with chronic liver disease.Data sourcesWe searched various databases from 1998 to April 2012, recent conference proceedings and reference lists.MethodsWe included studies that assessed the diagnostic accuracy of NILTs using liver biopsy as the reference standard. Diagnostic studies were assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. Meta-analysis was conducted using the bivariate random-effects model with correlation between sensitivity and specificity (whenever possible). Decision models were used to evaluate the cost-effectiveness of the NILTs. Expected costs were estimated using a NHS perspective and health outcomes were measured as quality-adjusted life-years (QALYs). Markov models were developed to estimate long-term costs and QALYs following testing, and antiviral treatment where indicated, for chronic hepatitis B (HBV) and chronic hepatitis C (HCV). NILTs were compared with each other, sequential testing strategies, biopsy and strategies including no testing. For alcoholic liver disease (ALD), we assessed the cost-effectiveness of NILTs in the context of potentially increasing abstinence from alcohol. Owing to a lack of data and treatments specifically for fibrosis in patients with non-alcoholic fatty liver disease (NAFLD), the analysis was limited to an incremental cost per correct diagnosis. An analysis of NILTs to identify patients with cirrhosis for increased monitoring was also conducted.ResultsGiven a cost-effectiveness threshold of £20,000 per QALY, treating everyone with HCV without prior testing was cost-effective with an incremental cost-effectiveness ratio (ICER) of £9204. This was robust in most sensitivity analyses but sensitive to the extent of treatment benefit for patients with mild fibrosis. For HBV [hepatitis B e antigen (HBeAg)-negative)] this strategy had an ICER of £28,137, which was cost-effective only if the upper bound of the standard UK cost-effectiveness threshold range (£30,000) is acceptable. For HBeAg-positive disease, two NILTs applied sequentially (hyaluronic acid and magnetic resonance elastography) were cost-effective at a £20,000 threshold (ICER: £19,612); however, the results were highly uncertain, with several test strategies having similar expected outcomes and costs. For patients with ALD, liver biopsy was the cost-effective strategy, with an ICER of £822.LimitationsA substantial number of tests had only one study from which diagnostic accuracy was derived; therefore, there is a high risk of bias. Most NILTs did not have validated cut-offs for diagnosis of specific fibrosis stages. The findings of the ALD model were dependent on assuptions about abstinence rates assumptions and the modelling approach for NAFLD was hindered by the lack of evidence on clinically effective treatments.ConclusionsTreating everyone without NILTs is cost-effective for patients with HCV, but only for HBeAg-negative if the higher cost-effectiveness threshold is appropriate. For HBeAg-positive, two NILTs applied sequentially were cost-effective but highly uncertain. Further evidence for treatment effectiveness is required for ALD and NAFLD.Study registrationThis study is registered as PROSPERO CRD42011001561.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Section: Results: Hepatitis C Virusmentioning

confidence: 99%

Cost-effectiveness of non-invasive methods for assessment and monitoring of liver fibrosis and cirrhosis in patients with chronic liver disease: systematic review and economic evaluation

Crossan

Tsochatzis

Longworth

et al. 2015

Health Technology Assessment

147

190

View full text Add to dashboard Cite

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“…A study performed in a cohort of more than 1000 patients showed a good correlation between point SWE (Acoustic Radiation Force Impulse -ARFI Elastography) and histology, both in HBV and HCV chronic hepatitis. It also found that ARFI and TE seem to be equal for liver fibrosis evaluation [10]. Furthermore, two meta-analyses found good AUROCs values for liver fibrosis assessment and non-inferiority in comparison with TE [11,12].…”

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confidence: 91%

One or more elastographic methods for liver fibrosis assessment?

Sporea

2015

Med Ultrason

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In every day practice many patients with chronic hepatopathies of various aetiologies need to be evaluated. How do we do this? Traditionally, liver biopsy is the classical assessment method in chronic liver diseases. But in the last decade, development of non-invasive evaluation methods in liver diseases and patients' access to the newest medical information by means of internet, have made them to ask questions about how this evaluation can be done.Transient Elastography (TE) (FibroScan) is a validated method in many European countries (starting with France), and the European Guidelines (EASL) of HCV treatment recommend this method for non-invasive evaluation of liver fibrosis [1]. Why? Because there are a great many papers showing a good correlation between the severity of liver fibrosis and TE measurements, especially for advanced fibrosis in HCV patients. Furthermore, three meta-analyses have proved a good correlation between histology and this method [2][3][4]. This is why TE is extensively used in many European countries and in Asia, and more recentlyit was approved by FDA in the United States. Following the good results of TE in HCV chronic infection, this method was used for HBV infection, NASH or others chronic hepatopathies. In Romania we have more than 25 FibroScan units extensively used in daily practice. This is why the number of liver biopsies have decreased dramatically in Romania in the last years [5]. The criticism for TE is that valid measurements can be obtained in only 70-85% of the patients using only the M probe [6,7], but this number can be increased to more than 90% using the XL probe. Other criticisms are the variability of measurements during time [8], the high maintenance cost of the system, with bi-annual calibration of the probe (increasing the initial cost of the FibroScan machine), and the blind modality for liver evaluation.During the last years, other ultrasound based elastographic methods, with a real time visualization of the liver parenchyma, were tested. Shear wave elastographic (SWE) methods (point SWE and 2D SWE) [9] are now implemented in many ultrasound machines (Siemens, Philips, Aixplorer, GE, Toshiba). Which are the advantages of such systems? Being implemented in standard ultrasound machines, these devices can also be used for daily ultrasound examination, to perform Contrast Enhanced ultrasound (CEUS) or Doppler evaluation. Thus we have a "one shop stop" in our hand. We can start with a standard ultrasound examination to find signs of chronic hepatopathy (liver or spleen enlargement, steatosis, heterogeneity of liver structure, signs of portal hypertension, etc), to find or exclude tumoral masses in the liver, or ascites and finally to immediately perform an elastographic evaluation, choosing the measurement place by gray scale ultrasound. Thus, Shear Wave Elastographic methods (point SWE or 2D SWE) seem to be ideal for daily practice. Another advantage is their price, roughly the same as using FibroScan, but they do not need biannual recalibration and also there is n...

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“…Cut-offs of 1.21 -1.34 m/s predict significant fibrosis (F ≥ 2) (AUROC 0.85 -0.89), while VTQ ® cut-offs between 1.55 and 2 m/s (AUROC 0.89 -0.93) predict cirrhosis [104,153]. The diagnostic performance of VTQ ® is comparable to TE [154] with high accuracy for predicting significant (F ≥ 2, AUROC 0.87) and severe fibrosis (F ≥ 3, AUROC 0.91) as well as cirrhosis (AUROC 0.93) [155].…”

Section: Point Shear Wave Elastography (Pswe)mentioning

confidence: 99%

Untitled

2017

Ultraschall in Med

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Acoustic Radiation Force Impulse Elastography for fibrosis evaluation in patients with chronic hepatitis C: An international multicenter study

Cited by 163 publications

References 17 publications

Cost-effectiveness of non-invasive methods for assessment and monitoring of liver fibrosis and cirrhosis in patients with chronic liver disease: systematic review and economic evaluation

Cost-effectiveness of non-invasive methods for assessment and monitoring of liver fibrosis and cirrhosis in patients with chronic liver disease: systematic review and economic evaluation

One or more elastographic methods for liver fibrosis assessment?

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