Original ArticlePancreas, Biliary Tract, and LiverCost Effectiveness of Different Strategies for Detecting Cirrhosis in Patients With Nonalcoholic Fatty Liver Disease Based on United States Health Care System
Section snippets
Study Population
Our study population consisted of a hypothetical cohort of middle-aged patients with NAFLD seen in 3 different settings: (1) in a specialty clinic setting in which the prevalence of cirrhosis in NAFLD is estimated to be 2%,11 (2) in a general population-based setting in which the prevalence of cirrhosis is estimated to be 0.27%,12 and (3) a tertiary referral center setting in which cirrhosis prevalence is reported to be approximately 4%.5,7,8
Model Structures
We constructed a decision model to compare the
Low prevalence of cirrhosis (0.27%)
Fib-4 alone correctly classified the lowest percentage of persons (57%), whereas Fib-4 + LB correctly classified 97.7%, the highest percentage (Table 2). Figure 2A shows diagnostic accuracy by cost per person for each strategy. The solid line connecting the blue dots represents the efficiency frontier, which identifies strategies with the lowest cost and highest accuracy, and includes the following: Fib-4 + VCTE (89.3%; $401), Fib-4 + MRE (92.4%; $491), and Fib-4 + LB (97.7%; $729). Relative to
Discussion
Because cirrhosis is the major determinant of long-term morbidity and mortality in patients with NAFLD, there is a critical need to detect cirrhosis before complications occur, which are associated with high mortality and increased health care utilization. The sequential combination of 2 NITs or a NIT test plus LB may detect cirrhosis more accurately,9,10 however, whether these approaches are cost effective is unknown. This study suggests that the use of Fib-4 followed by VCTE is likely the
Acknowledgments
The authors thank Ms Carolina Vivas-Valencia from the Purdue Weldon School of Biomedical Engineering for her participation in initial meetings on decision tree construction and conceptualization of the microsimulation; Mr Robert W. Klein from Medical Decision Modeling, Inc, for his thoughtful review and suggestions; Drs Samer Gawrieh and Niharika Samala for their comments regarding study design and results; and Julianne Nanzer for her editorial assistance.
CRediT Authorship Contributions
Eduardo Vilar-Gomez, M.D., Ph.D.
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2023, Clinics in Liver DiseaseCitation Excerpt :For example, FibroSure and Fibrospect II have reported average costs of $215 and $350, respectively.34 Excluding equipment costs and focusing on billed costs, a VCTE (FibroScan) costs approximately $140, whereas MRE is $481.35 The cost of ARFI and 2D-SWE likely approximates that of VCTE at approximately $150.36
Conflicts of interest This author discloses the following: Naga Chalasani has consulted for NuSirt, AbbVie, Afimmune (DS Biopharma), Allergan (Tobira), Madrigal, Coherus, Siemens, La Jolla, Foresite Labs, and Genentech; has received research grant support from Exact Sciences, Intercept, and Galectin Therapeutics; and has served as a paid consultant to more than 35 pharmaceutical companies. The remaining authors disclose no conflicts.
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Authors share co-first authorship.