The University of Southampton
University of Southampton Institutional Repository

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

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

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.

1-15
Srivastava, Ankur
6c45ba97-4517-4f4e-992c-03e7d305ed47
Jong, Simcha
fd86a234-9015-4c5a-818e-112eb1627bc1
Gola, Anna
fb80d002-8a18-498f-b7ef-a7f56a9169ff
Gailer, Ruth
82f6984a-c3af-400f-9cf6-0b03d651bfa7
Morgan, Sarah
2843f219-71cb-4748-bd79-6fa035330eac
Sennett, Karen
d295e314-5a5e-4d01-8090-6738fc759443
Tanwar, Sudeep
61efeab7-e746-4a8f-9170-2e6d95278fcd
Pizzo, Elena
f1eedd6d-826c-406a-ad7d-f6761b92c237
O'Beirne, James
9141c0e0-48ec-4c90-9cf2-2f58423afe0d
Tsochatzis, Emmanuel
92ff645c-80b7-444d-bcdd-c21317cd6500
Parkes, Julie
59dc6de3-4018-415e-bb99-13552f97e984
Rosenberg, William
145ebec3-ffb6-45e7-8711-aa520ed42f55
Srivastava, Ankur
6c45ba97-4517-4f4e-992c-03e7d305ed47
Jong, Simcha
fd86a234-9015-4c5a-818e-112eb1627bc1
Gola, Anna
fb80d002-8a18-498f-b7ef-a7f56a9169ff
Gailer, Ruth
82f6984a-c3af-400f-9cf6-0b03d651bfa7
Morgan, Sarah
2843f219-71cb-4748-bd79-6fa035330eac
Sennett, Karen
d295e314-5a5e-4d01-8090-6738fc759443
Tanwar, Sudeep
61efeab7-e746-4a8f-9170-2e6d95278fcd
Pizzo, Elena
f1eedd6d-826c-406a-ad7d-f6761b92c237
O'Beirne, James
9141c0e0-48ec-4c90-9cf2-2f58423afe0d
Tsochatzis, Emmanuel
92ff645c-80b7-444d-bcdd-c21317cd6500
Parkes, Julie
59dc6de3-4018-415e-bb99-13552f97e984
Rosenberg, William
145ebec3-ffb6-45e7-8711-aa520ed42f55

Srivastava, Ankur, Jong, Simcha, Gola, Anna, Gailer, Ruth, Morgan, Sarah, Sennett, Karen, Tanwar, Sudeep, Pizzo, Elena, O'Beirne, James, Tsochatzis, Emmanuel, Parkes, Julie and Rosenberg, William (2019) Cost-comparison analysis of FIB-4, ELF and fibroscan in community pathways for non-alcoholic fatty liver disease. BMC Gastroenterology, 19 (1), 1-15, [122]. (doi:10.1186/s12876-019-1039-4).

Record type: Article

Abstract

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.

Text
document(5) - Version of Record
Available under License Creative Commons Attribution.
Download (3MB)

More information

Accepted/In Press date: 26 June 2019
Published date: 11 July 2019

Identifiers

Local EPrints ID: 432640
URI: http://eprints.soton.ac.uk/id/eprint/432640
PURE UUID: ef4b6a5f-f3f8-4c41-b064-0d8885f6ac1d
ORCID for Julie Parkes: ORCID iD orcid.org/0000-0002-6490-395X

Catalogue record

Date deposited: 23 Jul 2019 16:30
Last modified: 16 Mar 2024 03:02

Export record

Altmetrics

Contributors

Author: Ankur Srivastava
Author: Simcha Jong
Author: Anna Gola
Author: Ruth Gailer
Author: Sarah Morgan
Author: Karen Sennett
Author: Sudeep Tanwar
Author: Elena Pizzo
Author: James O'Beirne
Author: Emmanuel Tsochatzis
Author: Julie Parkes ORCID iD
Author: William Rosenberg

Download statistics

Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.

View more statistics

Atom RSS 1.0 RSS 2.0

Contact ePrints Soton: eprints@soton.ac.uk

ePrints Soton supports OAI 2.0 with a base URL of http://eprints.soton.ac.uk/cgi/oai2

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.

×