Modelling the cost effectiveness of non-alcoholic fatty liver disease risk stratification strategies in the community setting.
<h4>Background</h4>Non-alcoholic fatty liver disease (NAFLD) is highly prevalent worldwide. Identifying high-risk patients is critical to best utilize limited health care resources. We established a community-based care pathway using 2D ultrasound shear wave elastography (SWE) to identif...
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2021-01-01
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| Series: | PLoS ONE |
| Online Access: | https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0251741&type=printable |
| _version_ | 1826554556176138240 |
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| author | Stephen E Congly Abdel Aziz Shaheen Mark G Swain |
| author_facet | Stephen E Congly Abdel Aziz Shaheen Mark G Swain |
| author_sort | Stephen E Congly |
| collection | DOAJ |
| description | <h4>Background</h4>Non-alcoholic fatty liver disease (NAFLD) is highly prevalent worldwide. Identifying high-risk patients is critical to best utilize limited health care resources. We established a community-based care pathway using 2D ultrasound shear wave elastography (SWE) to identify high risk patients with NAFLD. Our objective was to assess the cost-effectiveness of various non-invasive strategies to correctly identify high-risk patients.<h4>Methods</h4>A decision-analytic model was created using a payer's perspective for a hypothetical patient with NAFLD. FIB-4 [≥1.3], NAFLD fibrosis score (NFS) [≥-1.455], SWE [≥8 kPa], transient elastography (TE) [≥8 kPa], and sequential strategies with FIB-4 or NFS followed by either SWE or TE were compared to identify patients with either significant (≥F2) or advanced fibrosis (≥F3). Model inputs were obtained from local data and published literature. The cost/correct diagnosis of advanced NAFLD was obtained and univariate sensitivity analysis was performed.<h4>Results</h4>For ≥F2 fibrosis, FIB-4/SWE cost $148.75/correct diagnosis while SWE cost $276.42/correct diagnosis, identifying 84% of patients correctly. For ≥F3 fibrosis, using FIB-4/SWE correctly identified 92% of diagnoses and dominated all other strategies. The ranking of strategies was unchanged when stratified by normal or abnormal ALT. For ≥F3 fibrosis, the cost/correct diagnosis was less in the normal ALT group.<h4>Conclusions</h4>SWE based strategies were the most cost effective for diagnosing ≥F2 fibrosis. For ≥F3 fibrosis, FIB-4 followed by SWE was the most effective and least costly strategy. Further evaluation of the timing of repeating non-invasive strategies are required to enhance the cost-effective management of NAFLD. |
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| format | Article |
| id | doaj.art-70a7b554ca7d454da01e043ed3390e6a |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2025-03-14T07:42:47Z |
| publishDate | 2021-01-01 |
| publisher | Public Library of Science (PLoS) |
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| series | PLoS ONE |
| spelling | doaj.art-70a7b554ca7d454da01e043ed3390e6a2025-03-03T05:34:14ZengPublic Library of Science (PLoS)PLoS ONE1932-62032021-01-01165e025174110.1371/journal.pone.0251741Modelling the cost effectiveness of non-alcoholic fatty liver disease risk stratification strategies in the community setting.Stephen E ConglyAbdel Aziz ShaheenMark G Swain<h4>Background</h4>Non-alcoholic fatty liver disease (NAFLD) is highly prevalent worldwide. Identifying high-risk patients is critical to best utilize limited health care resources. We established a community-based care pathway using 2D ultrasound shear wave elastography (SWE) to identify high risk patients with NAFLD. Our objective was to assess the cost-effectiveness of various non-invasive strategies to correctly identify high-risk patients.<h4>Methods</h4>A decision-analytic model was created using a payer's perspective for a hypothetical patient with NAFLD. FIB-4 [≥1.3], NAFLD fibrosis score (NFS) [≥-1.455], SWE [≥8 kPa], transient elastography (TE) [≥8 kPa], and sequential strategies with FIB-4 or NFS followed by either SWE or TE were compared to identify patients with either significant (≥F2) or advanced fibrosis (≥F3). Model inputs were obtained from local data and published literature. The cost/correct diagnosis of advanced NAFLD was obtained and univariate sensitivity analysis was performed.<h4>Results</h4>For ≥F2 fibrosis, FIB-4/SWE cost $148.75/correct diagnosis while SWE cost $276.42/correct diagnosis, identifying 84% of patients correctly. For ≥F3 fibrosis, using FIB-4/SWE correctly identified 92% of diagnoses and dominated all other strategies. The ranking of strategies was unchanged when stratified by normal or abnormal ALT. For ≥F3 fibrosis, the cost/correct diagnosis was less in the normal ALT group.<h4>Conclusions</h4>SWE based strategies were the most cost effective for diagnosing ≥F2 fibrosis. For ≥F3 fibrosis, FIB-4 followed by SWE was the most effective and least costly strategy. Further evaluation of the timing of repeating non-invasive strategies are required to enhance the cost-effective management of NAFLD.https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0251741&type=printable |
| spellingShingle | Stephen E Congly Abdel Aziz Shaheen Mark G Swain Modelling the cost effectiveness of non-alcoholic fatty liver disease risk stratification strategies in the community setting. PLoS ONE |
| title | Modelling the cost effectiveness of non-alcoholic fatty liver disease risk stratification strategies in the community setting. |
| title_full | Modelling the cost effectiveness of non-alcoholic fatty liver disease risk stratification strategies in the community setting. |
| title_fullStr | Modelling the cost effectiveness of non-alcoholic fatty liver disease risk stratification strategies in the community setting. |
| title_full_unstemmed | Modelling the cost effectiveness of non-alcoholic fatty liver disease risk stratification strategies in the community setting. |
| title_short | Modelling the cost effectiveness of non-alcoholic fatty liver disease risk stratification strategies in the community setting. |
| title_sort | modelling the cost effectiveness of non alcoholic fatty liver disease risk stratification strategies in the community setting |
| url | https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0251741&type=printable |
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