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Cost-effectiveness of noninvasive liver fibrosis tests for treatment decisions in patients with chronic hepatitis C....... "treat all"
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"The results of our economic modeling and analysis indicate that a treat all strategy with currently available drugs is the most cost-effective strategy in patients with CHC in the UK. Given the similar health costs and treatment pathways for CHC in Western countries, it is reasonable to extrapolate that this holds true for most countries in the developed world."
"In conclusion, we have shown that treating all adult patients with CHC, irrespective of fibrosis stage, is the most cost-effective strategy with current standard treatments in developed countries. Licensing of more potent and expensive antiviral treatment, such as SOF, does appear to be cost-effective given the current price; however, more costly combinations could change these findings. Further analyses of such treatments are required to determine their cost-effectiveness. Because studies of NITs had a high risk of bias, better-quality data are urgently needed to validate their reported diagnostic accuracy."
"We performed a systematic review and meta-analysis to determine the diagnostic accuracy of NITs, compared to liver biopsy, in adult patients with CHC. This was part of a larger project funded by the UK National Institute for Health Research Health Technology Assessment Program that determined the cost-effectiveness of NITs in patients with hepatitis B virus, hepatitis C virus (HCV), alcoholic liver disease, and nonalcoholic fatty liver disease."
Emmanuel A. Tsochatzis,1* Catriona Crossan,2* Louise Longworth,2 Kurinchi Gurusamy,3 Manolo Rodriguez-Peralvarez,1 Konstantinos Mantzoukis,1 Julia O'Brien,1 Evangelos Thalassinos,1 Vassilios Papastergiou,1 Anna Noel-Storr,4 Brian Davidson,3 and Andrew K Burroughs1
From the 1Sheila Sherlock Liver Unit and UCL Institute for Liver and Digestive Health, Royal Free Hospital, London, UK; 2Health Economics Research Group,
Brunel University, Uxbridge, UK; 3Royal Free Campus, UCL Medical School, London, UK; 4Cochrane Dementia and Cognitive Improvement Group, Nuffield
Department of Medicine, Oxford University, Oxford, UK.
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.
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