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European Radiology
Erschienen in: European Radiology 11/2015

01.11.2015 | Gastrointestinal

Cost-utility analysis of nonalcoholic steatohepatitis screening

verfasst von: Eric Zhang, Claire Wartelle-Bladou, Luigi Lepanto, Jean Lachaine, Guy Cloutier, An Tang

Erschienen in: European Radiology | Ausgabe 11/2015

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Abstract

Objectives

Nonalcoholic fatty liver disease (NAFLD) is the most common liver disease in Western countries. No studies have examined the cost-effectiveness of screening its advanced form, nonalcoholic steatohepatitis (NASH).

Methods

We performed a cost-utility analysis of annual noninvasive screening strategies using third-party payer perspective in a general population in comparison to screening a high-risk obese or diabetic population. Screening algorithms involved well-studied techniques, including NAFLD fibrosis score, transient elastography (TE), and acoustic radiation force impulse (ARFI) imaging for detecting advanced fibrosis (≥ F3); and plasma cytokeratin (CK)-18 for NASH detection. Liver biopsy and magnetic resonance elastography (MRE) were compared as confirmation methods. Canadian dollar (CAD or C$) costs were adjusted for inflation and discounted at 5 %. Incremental cost-effectiveness ratio (ICER) of ≤C$ 50,000 was considered cost-effective.

Results

Compared with no screening, screening with NAFLD fibrosis score/TE/CK-18 algorithm with MRE as confirmation for advanced fibrosis had an ICER of C$ 26,143 per quality-adjusted life year (QALY) gained. Screening in high-risk obese or diabetic populations was more cost-effective, with an ICER of C$ 9,051 and C$ 7,991 per quality-adjusted life-year (QALY) gained, respectively. Liver biopsy confirmation was not found to be cost-effective.

Conclusions

Our model suggests that annual NASH screening in high-risk obese or diabetic populations can be cost-effective.

Key Points

• This cost-utility analysis suggests that screening for nonalcoholic steatohepatitis may be cost-effective.
• In particular, screening of high-risk obese or diabetic populations is more cost-effective.
• Magnetic resonance elastography was more cost-effective to confirm disease compared to biopsy.
• More studies are needed to determine quality of life in nonalcoholic steatohepatitis.
• More management strategies for nonalcoholic steatohepatitis are also needed.
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Metadaten
Titel
Cost-utility analysis of nonalcoholic steatohepatitis screening
verfasst von
Eric Zhang
Claire Wartelle-Bladou
Luigi Lepanto
Jean Lachaine
Guy Cloutier
An Tang
Publikationsdatum
01.11.2015
Verlag
Springer Berlin Heidelberg
Erschienen in
European Radiology / Ausgabe 11/2015
Print ISSN: 0938-7994
Elektronische ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-015-3731-2

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