Cost-effectiveness of noninvasive liver fibrosis tests for treatment decisions in patients with chronic hepatitis C

Abstract

The cost-effectiveness of noninvasive tests (NITs) as alternatives to liver biopsy is unknown. We compared the cost-effectiveness of using NITs to inform treatment decisions in adult patients with chronic hepatitis C (CHC). We conducted a systematic review and meta-analysis to calculate the diagnostic accuracy of various NITs using a bivariate random-effects model. We constructed a probabilistic decision analytical model to estimate health care costs and outcomes (quality-adjusted life-years; QALYs) using data from the meta-analysis, literature, and national UK data. We compared the cost-effectiveness of four treatment strategies: testing with NITs and treating patients with fibrosis stage ≥F2; testing with liver biopsy and treating patients with ≥F2; treat none; and treat all irrespective of fibrosis. We compared all NITs and tested the cost-effectiveness using current triple therapy with boceprevir or telaprevir, but also modeled new, more-potent antivirals. Treating all patients without any previous NIT was the most effective strategy and had an incremental cost-effectiveness ratio (ICER) of £9,204 per additional QALY gained. The exploratory analysis of currently licensed sofosbuvir treatment regimens found that treat all was cost-effective, compared to using an NIT to decide on treatment, with an ICER of £16,028 per QALY gained. The exploratory analysis to assess the possible effect on results of new treatments, found that if SVR rates increased to >90% for genotypes 1-4, the incremental treatment cost threshold for the “treat all” strategy to remain the most cost-effective strategy would be £37,500. Above this threshold, the most cost-effective option would be noninvasive testing with magnetic resonance elastography (ICER = £9,189). Conclusions: Treating all adult patients with CHC, irrespective of fibrosis stage, is the most cost-effective strategy with currently available drugs in developed countries. (Hepatology 2014;60:832–843)

Non-invasive Diagnostics of Liver Fibrosis

“…The test is an indicator not only of the stage of fi brosis but also for necrosis and infl ammatory activity [6,7,17,27]. [7,15,19]. It includes the number of platelets, AST and concentration of IgG.…”

Nem invazív fibrosisdiagnosztika hepatitis C-vírus-infekcióban: szerepe a kezelés indikációjában, követésében és a prognózis megítélésében

“…Mindez tükrözi a fi brosisdiagnosztika jelentőségét a HCV-terá-pia megválasztásában. Amennyiben minden felnőtt HCV-beteg kapna antivirális kezelést, költséghatékony-sági szempontból már nem lenne jelentősége a fi brosisstádiumok megkülönböztetésének [24].…”

Serum Immunoreactive Collagen IV detected by Monoclonal Antibodies as a Marker of Severe Fibrosis in Patients with Non- Alcoholic Fatty Liver Disease

“…However, liver biopsy is invasive and may pose risks including intra-abdominal bleeding and death in rare cases [14,15]. In addition, hospitalization during liver biopsy may increase healthcare costs [16]. Therefore, liver biopsy for all NAFLD patients is unrealistic; establishing a non-invasive method to easily and accurately distinguish severe fibrosis in NASH is an urgent issue.…”