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Cost-effectiveness of noninvasive liver fibrosis tests for treatment decisions in patients with chronic hepatitis C.

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 - Hepatology (2014)

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.

View Article: PubMed Central - PubMed

Affiliation: Sheila Sherlock Liver Unit and UCL Institute for Liver and Digestive Health, Royal Free Hospital, London, UK.

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Related in: MedlinePlus

Illustration of the Markov model used for economic analysis. The disease stages reflect the Metavir staging score for liver fibrosis and cirrhosis. The cohort represents those suspected of liver fibrosis who can enter the models in one of three disease stages: mild fibrosis (Metavir stages F0-F1), moderate fibrosis (Metavir stages F2-F3), and compensated cirrhosis (Metavir stage F4), with the proportions determined by the prevalence estimated from the results of the systematic review (prevalence ≥F2: 53%). Within the model, patients can remain within any disease stage for longer than one cycle (length of cycle is set as 1 year), except for the LT disease stage, where patients can only progress to either a post-LT stage or death.
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fig01: Illustration of the Markov model used for economic analysis. The disease stages reflect the Metavir staging score for liver fibrosis and cirrhosis. The cohort represents those suspected of liver fibrosis who can enter the models in one of three disease stages: mild fibrosis (Metavir stages F0-F1), moderate fibrosis (Metavir stages F2-F3), and compensated cirrhosis (Metavir stage F4), with the proportions determined by the prevalence estimated from the results of the systematic review (prevalence ≥F2: 53%). Within the model, patients can remain within any disease stage for longer than one cycle (length of cycle is set as 1 year), except for the LT disease stage, where patients can only progress to either a post-LT stage or death.

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.


Cost-effectiveness of noninvasive liver fibrosis tests for treatment decisions in patients with chronic hepatitis C.

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 - Hepatology (2014)

Illustration of the Markov model used for economic analysis. The disease stages reflect the Metavir staging score for liver fibrosis and cirrhosis. The cohort represents those suspected of liver fibrosis who can enter the models in one of three disease stages: mild fibrosis (Metavir stages F0-F1), moderate fibrosis (Metavir stages F2-F3), and compensated cirrhosis (Metavir stage F4), with the proportions determined by the prevalence estimated from the results of the systematic review (prevalence ≥F2: 53%). Within the model, patients can remain within any disease stage for longer than one cycle (length of cycle is set as 1 year), except for the LT disease stage, where patients can only progress to either a post-LT stage or death.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4265295&req=5

fig01: Illustration of the Markov model used for economic analysis. The disease stages reflect the Metavir staging score for liver fibrosis and cirrhosis. The cohort represents those suspected of liver fibrosis who can enter the models in one of three disease stages: mild fibrosis (Metavir stages F0-F1), moderate fibrosis (Metavir stages F2-F3), and compensated cirrhosis (Metavir stage F4), with the proportions determined by the prevalence estimated from the results of the systematic review (prevalence ≥F2: 53%). Within the model, patients can remain within any disease stage for longer than one cycle (length of cycle is set as 1 year), except for the LT disease stage, where patients can only progress to either a post-LT stage or death.
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.

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.

View Article: PubMed Central - PubMed

Affiliation: Sheila Sherlock Liver Unit and UCL Institute for Liver and Digestive Health, Royal Free Hospital, London, UK.

Show MeSH
Related in: MedlinePlus