Journal Article

Cost-comparison analysis of FIB-4, ELF and fibroscan in community pathways for non-alcoholic fatty liver disease

Gailer, Ruth, Tanwar, Sudeep, Jong, Simcha, Parkes, Julie, Rosenberg, William, Sennett, Karen, Srivastava, Ankur, Pizzo, Elena, Gola, Anna, Morgan, Sarah, O’Beirne, James, Tsochatzis, Emmanuel

2019

Overview

Background The identification of patients with advanced liver fibrosis secondary to non-alcoholic fatty liver disease (NAFLD) remains challenging. Using non-invasive liver fibrosis tests (NILT) in primary care may permit earlier detection of patients with clinically significant disease for specialist review, and reduce unnecessary referral of patients with mild disease. We constructed an analytical model to assess the clinical and cost differentials of such strategies. Methods A probabilistic decisional model simulated a cohort of 1000 NAFLD patients over 1 year from a healthcare payer perspective. Simulations compared standard care (SC) (scenario 1) to: Scenario 2: FIB-4 for all patients followed by Enhanced Liver Fibrosis (ELF) test for patients with indeterminate FIB-4 results; Scenario 3: FIB-4 followed by fibroscan for indeterminate FIB-4; Scenario 4: ELF alone; and Scenario 5: fibroscan alone. Model estimates were derived from the published literature. The primary outcome was cost per case of advanced fibrosis detected. Results Introduction of NILT increased detection of advanced fibrosis over 1 year by 114, 118, 129 and 137% compared to SC in scenarios 2, 3, 4 and 5 respectively with reduction in unnecessary referrals by 85, 78, 71 and 42% respectively. The cost per case of advanced fibrosis (METAVIR ≥F3) detected was £25,543, £8932, £9083, £9487 and £10,351 in scenarios 1, 2, 3, 4 and 5 respectively. Total budget spend was reduced by 25.2, 22.7, 15.1 and 4.0% in Scenarios 2, 3, 4 and 5 compared to £670 K at baseline. Conclusion Our analyses suggest that the use of NILT in primary care can increases early detection of advanced liver fibrosis and reduce unnecessary referral of patients with mild disease and is cost efficient. Adopting a two-tier approach improves resource utilization.

• Publisher: BioMed Central,BioMed Central Ltd,BMC
• Subject: Care and treatment / Cirrhosis detection / Complications and side effects / Computer Simulation / Cost benefit analysis / Cost savings / Costs and Cost Analysis / Critical Pathways - economics / Decision Support Techniques / Development and progression / Economic aspects / Elasticity Imaging Techniques - economics / Elasticity Imaging Techniques - methods / Enhanced Liver fibrosis (ELF) / Extracellular Matrix Proteins - analysis / Fatty liver / Fibroscan / Fibrosis / Gastroenterology / Hepatobiliary and pancreatic disorders / Hepatology / Humans / Internal Medicine / Liver Cirrhosis - diagnosis / Liver Cirrhosis - economics / Liver Cirrhosis - etiology / Liver Function Tests - economics / Liver Function Tests - methods / Medicine / Medicine & Public Health / NAFLD / Non-alcoholic Fatty Liver Disease - complications / Non-alcoholic Fatty Liver Disease - economics / Primary health care / Research Article