Cost-effectiveness of ultrasound-guided liver biopsy

Abstract

The risk of a major complication from ''blind'' percutaneous liver biopsy is reported to be in the range of 0.24% to 3.8%. In a recent randomized trial, patients whose liver biopsies were performed with ultrasonography had a significant reduction in complications requiring hospitalization compared with patients without ultrasound-guided biopsies (0.5% vs. 2.2%, P F .05). Despite this, routine use of ultrasonography for liver biopsies has not been implemented because of controversies with respect to costeffectiveness. The aim of our study was to analyze the relative cost-effectiveness of performing ultrasound-guided liver biopsies using decision analysis. A decision tree was constructed to compare a strategy of liver biopsy using ultrasonography with a strategy without ultrasonography. The major outcomes included were minor complications such as pain requiring analgesics and major complications, which require hospitalization. Costs included were direct medical costs from the payer's perspective. In our baseline model, the cost from complications per patient with and without ultrasonography was $62 and $129, respectively. The marginal effectiveness expressed as the number of major complications avoided was 1.2/100 liver biopsies. The incremental cost to avoid one major complication was $2,731. The model was most sensitive to the frequency of major complications and the additional cost of ultrasonography. Our decision analysis model suggests that ultrasoundguided liver biopsy is cost-effective. Future studies assessing the efficacy of image-guided liver biopsies should be conducted. (HEPATOLOGY 1998;27:1220-1226

Do the needle type and the operator experience influence liver biopsy specimen quality?

“…Concerning the use of ultrasound guidance of LB (in our study all the biopsies were performed echoguided or echoassisted), Younossi [12] showed that complications occurred in 4% of blind biopsies and in 2% of echoguided" biopsies (thus proving the cost-effectiveness of echoguidance). Pasha et al [13] found severe complications in 0.5% of ultrasound-guided LB and in 2.2% of blind biopsies (p<0.05). The same author showed that pain appeared more often (50%) in the blind biopsy group as compared to the ultrasound-guided biopsy group (37%, p=0.003).…”

A Study on the Safety of Liver Biopsy Inpatients with Von Willebrand’s Disease

“…The majority of complications (60%) occur within two hours, and 96% occur within 24 hours following the procedure [11] [12]. Less than 3% of patients following the procedure require inpatient carerelated to adverse event [7] [13]. A third of patients are known to experience significant pain during the procedure itself but clinically significant bleeding following the liver biopsy occurs only in 1% -2%, usually apparent within 4 hours post-procedure [6].…”

Transgastric Liver Biopsy Using the NOTES Technique: An Animal Study

“…Several large studies showed that the rate of major complication after PLB ranged from 0.09% to 2.3%, severe complications appeared in 0.57%, and mortality ranged from 0.03% to 0.11% [9][10][11]. And the complications of blind PLB are significant high rates compared with those of US-guided one [12][13][14], PLB under US guidance is recommended as a reasonable and cost-efficient procedure [1,13,15]. In fact, morbidity and mortality rates are not high.…”