Cost-utility analysis of nonalcoholic steatohepatitis screening

2015 European Radiology 25;11 (3282-3294)

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.

Pubmed : 25994191