title: Cost-effectiveness of noninvasive liver fibrosis tests for treatment decisions in patients with chronic hepatitis C.
abstract: The cost-effectiveness of noninvasive 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). 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 (quality-adjusted life-years; 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. Treating all patients without any previous NIT was the most effective strategy and had an incremental cost-effectiveness ratio (ICER) of £9,204 per 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 per QALY gained. The exploratory analysis to assess the possible effect 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 noninvasive testing with magnetic resonance 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.
authors.affiliation: Sheila Sherlock Liver Unit and UCL Institute for Liver and Digestive Health, Royal Free Hospital, London, UK.
authors.forename: Emmanuel A
authors.initials: EA
authors.lastname: Tsochatzis
authors.forename: Catriona
authors.initials: C
authors.lastname: Crossan
authors.forename: Louise
authors.initials: L
authors.lastname: Longworth
authors.forename: Kurinchi
authors.initials: K
authors.lastname: Gurusamy
authors.forename: Manolo
authors.initials: M
authors.lastname: Rodriguez-Peralvarez
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Mantzoukis
authors.forename: Julia
authors.initials: J
authors.lastname: O'Brien
authors.forename: Evangelos
authors.initials: E
authors.lastname: Thalassinos
authors.forename: Vassilios
authors.initials: V
authors.lastname: Papastergiou
authors.forename: Anna
authors.initials: A
authors.lastname: Noel-Storr
authors.forename: Brian
authors.initials: B
authors.lastname: Davidson
authors.forename: Andrew K
authors.initials: AK
authors.lastname: Burroughs
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D003657:Decision Making; D054459:Elasticity Imaging Techniques / Q000191:economics / Q000379:methods; D019698:Hepatitis C, Chronic / Q000188:drug therapy / Q000191:economics / Q000453:epidemiology*; D006801:Humans; D008103:Liver Cirrhosis / Q000188:drug therapy / Q000191:economics / Q000453:epidemiology*; D011237:Predictive Value of Tests
chemical_list: D000998:Antiviral Agents