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Cost-effectiveness of non-invasive 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; ... Burroughs, AK; + view all (2014) Cost-effectiveness of non-invasive liver fibrosis tests for treatment decisions in patients with chronic hepatitis C. Hepatology , 60 (3) 832- 843. 10.1002/hep.27296. Green open access

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Abstract

Background: The cost-effectiveness of non-invasive 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). Methods: 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 (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. Findings: Treating all patients without any prior NIT was the most effective strategy and had an incremental cost-effectiveness ratio (ICER) of £9,204/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/QALY gained. The exploratory analysis to assess the possible impact 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 non-invasive testing with MR 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. (Hepatology 2014).

Type: Article
Title: Cost-effectiveness of non-invasive liver fibrosis tests for treatment decisions in patients with chronic hepatitis C
Open access status: An open access version is available from UCL Discovery
DOI: 10.1002/hep.27296
Publisher version: http://dx.doi.org/10.1002/hep.27296
Language: English
Additional information: Copyright © 2014 The Authors. Hepatology published by Wiley on behalf of the American Association for the Study of Liver Diseases. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine > Inst for Liver and Digestive Hlth
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci > Department of Surgical Biotechnology
URI: https://discovery.ucl.ac.uk/id/eprint/1436069
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