title: Transient elastography for the diagnosis of liver fibrosis: a systematic review of economic evaluations.
abstract: Liver biopsy remains the gold standard for the diagnosis of liver fibrosis, but its use as a diagnostic tool is limited by its invasive nature and high cost.
  
  
  
  The aim of this study was to systematically review the cost-effectiveness of transient elastography (TE) with and without controlled attenuation parameter (CAP) for the diagnosis of liver fibrosis or steatosis in patients with hepatitis B, hepatitis C, alcoholic liver disease and non-alcoholic fatty liver disease.
  
  
  
  An economic literature search was performed. Eligibility criteria included systematic reviews, health technology assessments or economic evaluations of TE compared to liver biopsy and other non-invasive tests. After abstract screening, full-text reports of potentially relevant articles were assessed in duplicate. The methodological quality of the included studies was also appraised.
  
  
  
  The database search yielded 253 records; four cost-effectiveness and four cost-utility studies were included. The methodological quality of the included studies varies. High-quality cost-effectiveness studies not only suggested that TE is less costly but also less accurate than liver biopsy. The incremental cost-effectiveness ratio (ICER) of TE improves with a greater level of diagnostic accuracy and a higher degree of liver fibrosis. High-quality cost-utility studies indicated that TE is a cost-effective alternative to biopsy with ICER between $9000 and $14 000 per QALY for patients with hepatitis C. We did not find studies that assessed the cost-effectiveness of TE with CAP for the diagnosis of liver steatosis.
  
  
  
  Transient elastography is an economically attractive alternative to liver biopsy and other non-invasive diagnostic tests especially for patients with a higher degree of liver fibrosis.
authors.affiliation: Clinical Epidemiology Program, The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada.
authors.forename: Sasha
authors.initials: S
authors.lastname: van Katwyk
authors.affiliation: School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada.|Health Economics Research Group, Brunel University London, Uxbridge, UK.
authors.forename: Doug
authors.initials: D
authors.lastname: Coyle
authors.affiliation: Clinical Epidemiology Program, The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada.|Ottawa Hospital and Regional Hepatitis Program, The Ottawa Hospital, Ottawa, ON, Canada.|Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
authors.forename: Curtis
authors.initials: C
authors.lastname: Cooper
authors.affiliation: Clinical Epidemiology Program, The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada.
authors.forename: Kusala
authors.initials: K
authors.lastname: Pussegoda
authors.affiliation: Evidence Synthesis Group, Cornerstone Research Group, Burlington, ON, Canada.
authors.forename: Chris
authors.initials: C
authors.lastname: Cameron
authors.affiliation: Clinical Epidemiology Program, The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada.
authors.forename: Becky
authors.initials: B
authors.lastname: Skidmore
authors.affiliation: Health Quality Ontario, Toronto, ON, Canada.
authors.forename: Stacey
authors.initials: S
authors.lastname: Brener
authors.affiliation: Clinical Epidemiology Program, The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada.|School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Moher
authors.affiliation: Clinical Epidemiology Program, The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada.|School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada.|Institute of Clinical and Evaluative Sciences (ICES Ottawa), Ottawa, ON, Canada.
authors.forename: Kednapa
authors.initials: K
authors.lastname: Thavorn
mesh_terms: D001706:Biopsy / Q000191:economics; D003362:Cost-Benefit Analysis; D054459:Elasticity Imaging Techniques / Q000191:economics*; D006509:Hepatitis B / Q000150:complications; D006526:Hepatitis C / Q000150:complications; D006801:Humans; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging* / Q000473:pathology; D008108:Liver Diseases, Alcoholic / Q000150:complications; D065626:Non-alcoholic Fatty Liver Disease / Q000150:complications
keywords: chronic liver disease; controlled attenuation parameter; health economic evaluation; liver fibrosis/steatosis; systematic review; transient elastography