Cost-effectiveness of noninvasive liver fibrosis tests for treatment decisions in patients with chronic hepatitis C.
Bottom Line: 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.Above this threshold, the most cost-effective option would be noninvasive testing with magnetic resonance elastography (ICER=£9,189).Treating all adult patients with CHC, irrespective of fibrosis stage, is the most cost-effective strategy with currently available drugs in developed countries.
Affiliation: Sheila Sherlock Liver Unit and UCL Institute for Liver and Digestive Health, Royal Free Hospital, London, UK.Show MeSH
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Mentions: The analyses were based on a decision tree, combined with a Markov model to estimate the long-term costs and outcomes associated with each potential NIT diagnosis: TP, FP, FN, or TN and the treat all and treat no one testing strategies. The Markov model estimated the lifetime mean costs and outcomes for a hypothetical cohort of 1,000 patients with CHC genotypes 1-4, with suspected fibrosis, who would usually present for liver biopsy. The model structure is a modified version of previously published models of liver fibrosis in CHC (Fig. 1).8,9 We validated the model natural history outputs using data from a study that retrospectively assessed a cohort of patients who did not attain SVR after IFN treatment10; the outputs were similar for patients with F4.
Affiliation: Sheila Sherlock Liver Unit and UCL Institute for Liver and Digestive Health, Royal Free Hospital, London, UK.