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Title: Cost-effectiveness of noninvasive liver fibrosis tests for treatment decisions in patients with chronic hepatitis C
Authors: Tsochatzis, EA
Crossan, C
Longworth, L
Gurusamy, K
Rodriguez-Peralvarez, M
Mantzoukis, K
O'Brien, J
Thalassinos, E
Papastergiou, V
Noel-Storr, A
Davidson, B
Burroughs, AK
Keywords: Cost-effectiveness;Noninvasive tests (NITs)
Issue Date: 2014
Publisher: John Wiley and Sons Inc.
Citation: Hepatology, 60:3, pp. 832 - 843, 2014
Abstract: The cost-effectiveness of noninvasive 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). 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 (quality-adjusted life-years; 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. Treating all patients without any previous NIT was the most effective strategy and had an incremental cost-effectiveness ratio (ICER) of £9,204 per 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 per QALY gained. The exploratory analysis to assess the possible effect 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 noninvasive testing with magnetic resonance 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. © 2014 The Authors.
ISSN: 0270-9139
Appears in Collections:Health Economics Research Group (HERG)

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