Transient elastography for screening of liver fibrosis: Cost-effectiveness analysis from six prospective cohorts in Europe and Asia

摘要: Background & Aims Non-alcoholic fatty liver disease and alcohol-related pose an important challenge to current clinical healthcare pathways because of the large number at-risk patients. Therefore, we aimed explore cost-effectiveness transient elastography (TE) as a screening method detect fibrosis in primary care pathway. Methods Cost-effectiveness analysis was performed using real-life individual patient data from 6 independent prospective cohorts (5 Europe 1 Asia). A diagnostic algorithm with conditional inference trees developed relationships between stiffness, socio-demographics, comorbidities, hepatic fibrosis, latter assessed by scores (FIB-4, NFS) biopsies subset 352 We compared incremental strategy against standard alongside numbers needed screen diagnose stage ≥F2. Results The set encompassed 6,295 participants (mean age 55 ± 12 years, BMI 27 ± 5 kg/m2, stiffness 5.6 ± 5.0 kPa). 9.1 kPa TE cut-off provided best accuracy for diagnosis significant (≥F2) general population settings, whereas threshold 9.5 kPa optimal populations disease. proposed cut-offs outperformed terms accuracy. Screening cost-effective mean ratios ranging 2,570 €/QALY (95% CI 2,456–2,683) (age ≥45 years) 6,217 5,832–6,601) population. Overall, there 12% chance being cost saving across countries populations. Conclusions is intervention European Asian may even be saving. Lay summary lack optimized public health strategies detection adults without known presents major challenge. Analyses international cohorts, measurements, show that community-based risk-stratification non-alcoholic diseases potentially our systems, it leads earlier identification