title: Cost-effectiveness of noninvasive liver fibrosis tests for treatment decisions in patients with chronic hepatitis B in the UK: systematic review and economic evaluation.
abstract: We compared the cost-effectiveness of various noninvasive tests (NITs) in patients with chronic hepatitis B and elevated transaminases and/or viral load who would normally undergo liver biopsy to inform treatment decisions. We searched various databases until April 2012. 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 decision-making strategies: testing with NITs and treating patients with fibrosis stage ≥F2, testing with liver biopsy and treating patients with ≥F2, treat none (watchful waiting) and treat all irrespective of fibrosis. Treating all patients without prior fibrosis assessment had an incremental cost-effectiveness ratio (ICER) of £28,137 per additional QALY gained for HBeAg-negative patients. For HBeAg-positive patients, using Fibroscan was the most cost-effective option with an ICER of £23,345. The base case results remained robust in the majority of sensitivity analyses, but were sensitive to changes in the ≥ F2 prevalence and the benefit of treatment in patients with F0-F1. For HBeAg-negative patients, strategies excluding NITs were the most cost-effective: treating all patients regardless of fibrosis level if the high cost-effectiveness threshold of £30,000 is accepted; watchful waiting if not. For HBeAg-positive patients, using Fibroscan to identify and treat those with ≥F2 was the most cost-effective option.
authors.affiliation: Health Economics Research Group, Brunel University London, London, UK.
authors.forename: C
authors.initials: C
authors.lastname: Crossan
authors.affiliation: Sheila Sherlock Liver Unit and UCL Institute for Liver and Digestive Health, The Royal Free Hospital and UCL, London, UK.
authors.forename: E A
authors.initials: EA
authors.lastname: Tsochatzis
authors.affiliation: Health Economics Research Group, Brunel University London, London, UK.
authors.forename: L
authors.initials: L
authors.lastname: Longworth
authors.affiliation: Division of Surgery, Royal Free Campus, UCL Medical School, London, UK.
authors.forename: K
authors.initials: K
authors.lastname: Gurusamy
authors.affiliation: Health Economics Research Group, Brunel University London, London, UK.
authors.forename: V
authors.initials: V
authors.lastname: Papastergiou
authors.affiliation: Health Economics Research Group, Brunel University London, London, UK.
authors.forename: E
authors.initials: E
authors.lastname: Thalassinos
authors.affiliation: Health Economics Research Group, Brunel University London, London, UK.
authors.forename: K
authors.initials: K
authors.lastname: Mantzoukis
authors.affiliation: Health Economics Research Group, Brunel University London, London, UK.
authors.forename: M
authors.initials: M
authors.lastname: Rodriguez-Peralvarez
authors.affiliation: Health Economics Research Group, Brunel University London, London, UK.
authors.forename: J
authors.initials: J
authors.lastname: O'Brien
authors.affiliation: Cochrane Dementia and Cognitive Improvement Group, Nuffield Department of Medicine, Oxford University, Oxford, UK.
authors.forename: A
authors.initials: A
authors.lastname: Noel-Storr
authors.affiliation: Laiko Hospital, University Department of Gastroenterology, Athens, Greece.
authors.forename: G V
authors.initials: GV
authors.lastname: Papatheodoridis
authors.affiliation: Division of Surgery, Royal Free Campus, UCL Medical School, London, UK.
authors.forename: B
authors.initials: B
authors.lastname: Davidson
authors.affiliation: Sheila Sherlock Liver Unit and UCL Institute for Liver and Digestive Health, The Royal Free Hospital and UCL, London, UK.
authors.forename: A K
authors.initials: AK
authors.lastname: Burroughs
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D003951:Diagnostic Errors / Q000191:economics / Q000706:statistics & numerical data; D003955:Diagnostic Tests, Routine / Q000191:economics*; D017048:Health Care Costs; D006513:Hepatitis B e Antigens / Q000097:blood; D019694:Hepatitis B, Chronic; D006801:Humans; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000188:drug therapy / Q000191:economics*; D019057:Quality-Adjusted Life Years; D006113:United Kingdom; D019562:Viral Load
chemical_list: D000998:Antiviral Agents; D006513:Hepatitis B e Antigens
keywords: cirrhosis; fibroscan; fibrosis; incremental cost-effectiveness ratio; prognosis; quality-adjusted-life-years