title: Cost-utility analysis of nonalcoholic steatohepatitis screening.
abstract: OBJECTIVE
  Nonalcoholic fatty liver disease (NAFLD) is the most common liver disease in Western countries. No studies have examined the cost-effectiveness of screening its advanced form, nonalcoholic steatohepatitis (NASH).
  
  
  METHODS
  We performed a cost-utility analysis of annual noninvasive screening strategies using third-party payer perspective in a general population in comparison to screening a high-risk obese or diabetic population. Screening algorithms involved well-studied techniques, including NAFLD fibrosis score, transient elastography (TE), and acoustic radiation force impulse (ARFI) imaging for detecting advanced fibrosis (≥ F3); and plasma cytokeratin (CK)-18 for NASH detection. Liver biopsy and magnetic resonance elastography (MRE) were compared as confirmation methods. Canadian dollar (CAD or C$) costs were adjusted for inflation and discounted at 5%. Incremental cost-effectiveness ratio (ICER) of ≤C$ 50,000 was considered cost-effective.
  
  
  RESULTS
  Compared with no screening, screening with NAFLD fibrosis score/TE/CK-18 algorithm with MRE as confirmation for advanced fibrosis had an ICER of C$ 26,143 per quality-adjusted life year (QALY) gained. Screening in high-risk obese or diabetic populations was more cost-effective, with an ICER of C$ 9,051 and C$ 7,991 per quality-adjusted life-year (QALY) gained, respectively. Liver biopsy confirmation was not found to be cost-effective.
  
  
  CONCLUSIONS
  Our model suggests that annual NASH screening in high-risk obese or diabetic populations can be cost-effective.
  
  
  CONCLUSIONS
  • This cost-utility analysis suggests that screening for nonalcoholic steatohepatitis may be cost-effective. • In particular, screening of high-risk obese or diabetic populations is more cost-effective. • Magnetic resonance elastography was more cost-effective to confirm disease compared to biopsy. • More studies are needed to determine quality of life in nonalcoholic steatohepatitis. • More management strategies for nonalcoholic steatohepatitis are also needed.
authors.affiliation: Department of Radiology, Radio-Oncology and Nuclear Medicine, University of Montreal, Saint-Luc Hospital, Montreal, Quebec, Canada.|Laboratory of Biorheology and Medical Ultrasonics, University of Montreal Hospital Research Center (CRCHUM), Montreal, Quebec, Canada.
authors.forename: Eric
authors.initials: E
authors.lastname: Zhang
authors.affiliation: Department of Gastroenterology and Hepatology, University of Montreal, Saint-Luc Hospital, Montreal, Quebec, Canada.
authors.forename: Claire
authors.initials: C
authors.lastname: Wartelle-Bladou
authors.affiliation: Department of Radiology, Radio-Oncology and Nuclear Medicine, University of Montreal, Saint-Luc Hospital, Montreal, Quebec, Canada.|Health Technology Assessment Unit, University of Montreal, Saint-Luc Hospital, Montreal, Quebec, Canada.
authors.forename: Luigi
authors.initials: L
authors.lastname: Lepanto
authors.affiliation: Faculty of Pharmacy and Pharmacoeconomics, University of Montreal, Montreal, Quebec, Canada.
authors.forename: Jean
authors.initials: J
authors.lastname: Lachaine
authors.affiliation: Department of Radiology, Radio-Oncology and Nuclear Medicine, University of Montreal, Saint-Luc Hospital, Montreal, Quebec, Canada.|Laboratory of Biorheology and Medical Ultrasonics, University of Montreal Hospital Research Center (CRCHUM), Montreal, Quebec, Canada.
authors.forename: Guy
authors.initials: G
authors.lastname: Cloutier
authors.affiliation: Department of Radiology, Radio-Oncology and Nuclear Medicine, University of Montreal, Saint-Luc Hospital, Montreal, Quebec, Canada. an.tang@umontreal.ca.|Laboratory of Biorheology and Medical Ultrasonics, University of Montreal Hospital Research Center (CRCHUM), Montreal, Quebec, Canada. an.tang@umontreal.ca.
authors.forename: An
authors.initials: A
authors.lastname: Tang
mesh_terms: D001706:Biopsy; D002170:Canada; D003362:Cost-Benefit Analysis; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000191:economics; D042241:Early Diagnosis; D054459:Elasticity Imaging Techniques / Q000379:methods; D006801:Humans; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000191:economics; D008390:Markov Chains; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000175:diagnosis* / Q000191:economics; D009765:Obesity / Q000150:complications / Q000191:economics; D063868:Patient Outcome Assessment; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D012307:Risk Factors
keywords: Cost-effectiveness; Elastography; Fibrosis; Nonalcoholic fatty liver disease (NAFLD); Screening