title: Ultrasound elastography for fibrosis surveillance is cost effective in patients with chronic hepatitis C virus in the UK.
abstract: BACKGROUND
  Chronic hepatitis C (HCV) is a significant risk factor for cirrhosis and subsequently hepatocellular carcinoma (HCC). HCV patients with cirrhosis are screened for HCC every 6 months. Surveillance for progression to cirrhosis and consequently access to HCC screening is not standardized. Liver biopsy, the usual test to determine cirrhosis, carries a significant risk of morbidity and associated mortality. Transient ultrasound elastography (fibroscan) is a non-invasive test for cirrhosis.
  
  
  OBJECTIVE
  This study assesses the cost effectiveness of annual surveillance for cirrhosis in patients with chronic HCV and the effect of replacing biopsy with fibroscan to diagnose cirrhosis.
  
  
  METHODS
  A Markov decision analytic model simulated a hypothetical cohort of 10,000 patients with chronic HCV initially without fibrosis over their lifetime. The cirrhosis surveillance strategies assessed were: no surveillance; current practice; fibroscan in current practice with biopsy to confirm cirrhosis; fibroscan completely replacing biopsy in current practice (definitive); annual biopsy; annual fibroscan with biopsy to confirm cirrhosis; annual definitive fibroscan.
  
  
  RESULTS
  Our results demonstrate that annual definitive fibroscan is the optimal strategy to diagnose cirrhosis. In our study, it diagnosed 20 % more cirrhosis cases than the current strategy, with 549 extra patients per 10,000 accessing screening over a lifetime and, consequently, 76 additional HCC cases diagnosed. The lifetime cost is £98.78 extra per patient compared to the current strategy for 1.72 additional unadjusted life years. Annual fibroscan surveillance of 132 patients results in the diagnosis one additional HCC case over a lifetime. The incremental cost-effectiveness ratio for an annual definitive fibroscan is £6,557.06/quality-adjusted life years gained.
  
  
  CONCLUSIONS
  Annual definitive fibroscan may be a cost-effective surveillance strategy to identify cirrhosis in patients with chronic HCV, thereby allowing access of these patients to HCC screening.
authors.affiliation: Division of Epidemiology and Public Health, Nottingham University, Clinical Sciences Building, City Hospital Campus, Hucknall Road, Nottingham, NG5 1PB, UK. mczcpc@nottingham.ac.uk
authors.forename: C
authors.initials: C
authors.lastname: Canavan
authors.forename: J
authors.initials: J
authors.lastname: Eisenburg
authors.forename: L
authors.initials: L
authors.lastname: Meng
authors.forename: K
authors.initials: K
authors.lastname: Corey
authors.forename: C
authors.initials: C
authors.lastname: Hur
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000473:pathology; D003362:Cost-Benefit Analysis; D054459:Elasticity Imaging Techniques / Q000191:economics*; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000473:pathology; D006801:Humans; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging* / Q000209:etiology / Q000473:pathology; D008113:Liver Neoplasms / Q000175:diagnosis / Q000473:pathology; D018803:Models, Economic; D011159:Population Surveillance; D012680:Sensitivity and Specificity; D006113:United Kingdom