Tsochatzis, EA;
Crossan, C;
Longworth, L;
Gurusamy, K;
Rodriguez-Peralvarez, M;
Mantzoukis, K;
O'Brien, J;
... Burroughs, AK; + view all
(2014)
Cost-effectiveness of non-invasive liver fibrosis tests for treatment decisions in patients with chronic hepatitis C.
Hepatology
, 60
(3)
832- 843.
10.1002/hep.27296.
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Abstract
Background: The cost-effectiveness of non-invasive tests (NITs) as alternatives to liver biopsy is unknown. We compared the cost-effectiveness of using NITs to inform treatment decisions in adult patients with chronic hepatitis C (CHC). Methods: We conducted a systematic review and meta-analysis to calculate the diagnostic accuracy of various NITs using a bivariate random-effects model. We constructed a probabilistic decision analytical model to estimate health care costs and outcomes (QALYs) using data from the meta-analysis, literature, and national UK data. We compared the cost-effectiveness of four treatment strategies: testing with NITs and treating patients with fibrosis stage ≥F2, testing with liver biopsy and treating patients with ≥F2, treat none and treat all irrespective of fibrosis. We compared all NITs and tested the cost-effectiveness using current triple therapy with boceprevir or telaprevir but also modeled new, more potent antivirals. Findings: Treating all patients without any prior NIT was the most effective strategy and had an incremental cost-effectiveness ratio (ICER) of £9,204/additional QALY gained. The exploratory analysis of currently licensed sofosbuvir treatment regimens found that treat all was cost-effective compared to using an NIT to decide on treatment, with an ICER of £16,028/QALY gained. The exploratory analysis to assess the possible impact on results of new treatments, found that if SVR rates increased to >90% for genotypes 1-4, the incremental treatment cost threshold for the "treat all" strategy to remain the most cost-effective strategy would be £37,500. Above this threshold, the most cost-effective option would be non-invasive testing with MR elastography (ICER=£9,189). Conclusions: Treating all adult patients with CHC, irrespective of fibrosis stage, is the most cost-effective strategy with currently available drugs in developed countries. (Hepatology 2014).
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