title: [Evaluation of the costs of transient elastography (FibroScan(®)) in the diagnosis of liver fibrosis in HIV patients with hepatitis C virus].
abstract: BACKGROUND
  The assessment of liver fibrosis is crucial for taking therapeutic decisions in patients infected with HIV/AIDS coinfected with HCV, because it allows the prognosis of the disease and the prioritization of hepatitis C treatment in these patients.
  
  
  METHODS
  A discrete events model simulation (DEMS) and a Markov model have been developed to represent the evolution of liver fibrosis to cirrhosis in patients coinfected with HIV/HVC. The model evaluated two alternatives for the diagnosis and monitoring of these patients, transient elastography performed annually and liver biopsy performed every seven years. The models have been developed under Health Care System perspective and only considered direct medical costs (disease treatment and health state costs). One-way sensitivity analyses were carried out to assess the impact of parameters with higher uncertainty. A discount rate of 3% was applied.
  
  
  RESULTS
  Base case analysis shows that the diagnosis and monitoring of patients with transient elastography is a dominant strategy compared with to liver biopsy, resulting in greater life expectancy at lower cost. The sensitivity analysis performed confirmed the robustness of these results.
  
  
  CONCLUSIONS
  Transient elastography has proved to be a dominant strategy compared to liver biopsy in the diagnosis and monitoring of liver fibrosis in patients coinfected with HIV/HCV in Spain.
authors.affiliation: Pharmacoeconomics & Outcomes Research Iberia, Madrid, España.
authors.forename: Laura
authors.initials: L
authors.lastname: García-Jurado
authors.forename: Itziar
authors.initials: I
authors.lastname: Oyagüez
authors.forename: Miguel Ángel
authors.initials: MÁ
authors.lastname: Casado
authors.forename: Cristina
authors.initials: C
authors.lastname: Tural
authors.forename: Juan
authors.initials: J
authors.lastname: González-García
authors.forename: Enrique
authors.initials: E
authors.lastname: Ortega
authors.forename: Juan Antonio
authors.initials: JA
authors.lastname: Pineda
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy / Q000191:economics; D002648:Child; D002675:Child, Preschool; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D018450:Disease Progression; D054459:Elasticity Imaging Techniques / Q000191:economics*; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology; D005102:Health Expenditures; D006526:Hepatitis C / Q000150:complications*; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging / Q000473:pathology; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000191:economics / Q000209:etiology / Q000473:pathology; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D008954:Models, Biological; D018803:Models, Economic; D011379:Prognosis; D012680:Sensitivity and Specificity; D013997:Time Factors; D055815:Young Adult