2021
DOI: 10.1371/journal.pone.0251741
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Modelling the cost effectiveness of non-alcoholic fatty liver disease risk stratification strategies in the community setting

Abstract: Background Non-alcoholic fatty liver disease (NAFLD) is highly prevalent worldwide. Identifying high-risk patients is critical to best utilize limited health care resources. We established a community-based care pathway using 2D ultrasound shear wave elastography (SWE) to identify high risk patients with NAFLD. Our objective was to assess the cost-effectiveness of various non-invasive strategies to correctly identify high-risk patients. Methods A decision-analytic model was created using a payer’s perspectiv… Show more

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Cited by 16 publications
(10 citation statements)
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“…These results are consistent across a wide range of target populations and health care systems, mostly in European settings. [8,[33][34][35][36][37] Estimates range between $6,000 per quality-adjusted life-year (QALY) in low-prevalence general population settings to $2,000 per QALY in at-risk populations, such as heavy alcohol consumers or patients with metabolic syndrome. These numbers are well below the thresholds that allow new therapies to enter the portfolio of covered services in most developed countries ($100,000 in the United States and between $25,000 and $50,000 in Europe).…”
Section: Cost-effecti Veness Of LI Ver Fibrosis Screeningmentioning
confidence: 99%
“…These results are consistent across a wide range of target populations and health care systems, mostly in European settings. [8,[33][34][35][36][37] Estimates range between $6,000 per quality-adjusted life-year (QALY) in low-prevalence general population settings to $2,000 per QALY in at-risk populations, such as heavy alcohol consumers or patients with metabolic syndrome. These numbers are well below the thresholds that allow new therapies to enter the portfolio of covered services in most developed countries ($100,000 in the United States and between $25,000 and $50,000 in Europe).…”
Section: Cost-effecti Veness Of LI Ver Fibrosis Screeningmentioning
confidence: 99%
“…This type of sequential strategy was proven to be cost-effective and able to mitigate unnecessary referrals. [2] However, there are multiple concerns regarding the use of FIB-4 as the first risk-stratifying step, including but not limited to (1) the poor correlation between FIB-4 and liver stiffness in the population with low prevalence of advanced liver fibrosis, [3,4] (2) high false-positive and false-negative rates among extreme age population, [3] and (3) suboptimal performance of blood-based biomarker for advanced liver fibrosis among people with diabetes, which is one of the inclusion criteria of identifying individuals at risk in this AGA Clinical Care Pathway. [5] Therefore, we aimed to explore the performance of this pathway in the United States (US) population.…”
Section: Introductionmentioning
confidence: 99%
“…This AGA Clinical Care Pathway utilizes the sequential strategy by using the Fibrosis‐4 (FIB‐4) score among at‐risk population, followed by liver stiffness measurement (LSM) in specific group. This type of sequential strategy was proven to be cost‐effective and able to mitigate unnecessary referrals 2. However, there are multiple concerns regarding the use of FIB‐4 as the first risk‐stratifying step, including but not limited to (1) the poor correlation between FIB‐4 and liver stiffness in the population with low prevalence of advanced liver fibrosis,3,4 (2) high false‐positive and false‐negative rates among extreme age population,3 and (3) suboptimal performance of blood‐based biomarker for advanced liver fibrosis among people with diabetes, which is one of the inclusion criteria of identifying individuals at risk in this AGA Clinical Care Pathway 5…”
Section: Introductionmentioning
confidence: 99%
“…However, existing methods for diagnosing fatty liver have some limitations. First, USG and TE are relatively expensive for repeated testing or use in general practice [ 19 , 20 ]. The average cost for conducting USG is USD 420 and for TE, USD 240 [ 19 ].…”
Section: Introductionmentioning
confidence: 99%
“…First, USG and TE are relatively expensive for repeated testing or use in general practice [ 19 , 20 ]. The average cost for conducting USG is USD 420 and for TE, USD 240 [ 19 ]. Second, both test methods can be performed only in specialized medical institutions.…”
Section: Introductionmentioning
confidence: 99%