van Katwyk Sasha, Coyle Doug, Cooper Curtis, Pussegoda Kusala, Cameron Chris, Skidmore Becky, Brener Stacey, Moher David, Thavorn Kednapa
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.
Liver Int. 2017 Jun;37(6):851-861. doi: 10.1111/liv.13260. Epub 2016 Oct 24.
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.
肝活检仍是诊断肝纤维化的金标准，但其作为一种诊断工具受到其侵入性和高成本的限制。
本研究旨在系统评价有无控制衰减参数（CAP）的瞬时弹性成像（TE）对乙型肝炎、丙型肝炎、酒精性肝病和非酒精性脂肪性肝病患者肝纤维化或脂肪变性诊断的成本效益。
进行了一项经济文献检索。纳入标准包括与肝活检和其他非侵入性检查相比，对TE的系统评价、卫生技术评估或经济评价。在摘要筛选后，对潜在相关文章的全文报告进行了双人评估。还对纳入研究的方法学质量进行了评价。
数据库检索产生了253条记录；纳入了四项成本效益研究和四项成本效用研究。纳入研究的方法学质量各不相同。高质量的成本效益研究不仅表明TE成本较低，而且比肝活检准确性更低。TE的增量成本效益比（ICER）随着诊断准确性的提高和肝纤维化程度的增加而改善。高质量的成本效用研究表明，对于丙型肝炎患者，TE是一种具有成本效益的活检替代方法，ICER为每质量调整生命年9000美元至14000美元。我们没有找到评估带CAP的TE对肝脂肪变性诊断的成本效益的研究。
瞬时弹性成像对于肝纤维化程度较高的患者而言，是一种在经济上有吸引力的肝活检和其他非侵入性诊断测试的替代方法。
