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

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

doi:10.1186/s12876-019-1039-4

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

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

Ankur Srivastava, Simcha Jong, Anna Gola, Ruth Gailer, S Morgan, Karen Sennett, Sudeep Tanwar, Elena Pizzo, James O'Beirne, Emmanuel Tsochatzis, …

BMC Gastroenterology, Vol.19, pp.1-15

2019

DOI: https://doi.org/10.1186/s12876-019-1039-4

PMCID: PMC6624894

PMID: 31296161

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Abstract

enhanced liver fibrosis (ELF)

fibroscan

NAFLD

cirrhosis detection

cost savings

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.

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Title: Cost-comparison analysis of FIB-4, ELF and fibroscan in community pathways for non-alcoholic fatty liver disease
Authors: Ankur Srivastava (Author) - University College London
Simcha Jong (Author) - Leiden University
Anna Gola (Author)
Ruth Gailer (Author) - Royal Free Hospital
S Morgan (Author) - Camden Clinical Commissioning Group - Camden, London, UK (CCCG)
Karen Sennett (Author) - Islington Clinical Commissioning Group - Islington, London (CCG)
Sudeep Tanwar (Author) - University College London
Elena Pizzo (Author) - University College London
James O'Beirne (Author) - University College London
Emmanuel Tsochatzis (Author) - University College London
Julie Parkes (Author) - University of Southampton
William Rosenberg (Author) - University College London
Publication details: BMC Gastroenterology, Vol.19, pp.1-15
Publisher: BioMed Central Ltd.
Date published: 2019
DOI: 10.1186/s12876-019-1039-4
ISSN: 1471-230X
PMID: 31296161; PMC6624894
Copyright note: This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Organisation Unit: University of the Sunshine Coast, Queensland; School of Health and Behavioural Sciences - Legacy
Language: English
Record Identifier: 99609708002621
Output Type: Journal article

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Web Of Science research areas: Gastroenterology & Hepatology

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