基于美国医疗保健体系的非酒精性脂肪性肝病患者肝硬化检测不同策略的成本效果分析。
Cost Effectiveness of Different Strategies for Detecting Cirrhosis in Patients With Nonalcoholic Fatty Liver Disease Based on United States Health Care System.
机构信息
Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana.
School of Industrial Engineering, Purdue University, West Lafayette, Indiana.
出版信息
Clin Gastroenterol Hepatol. 2020 Sep;18(10):2305-2314.e12. doi: 10.1016/j.cgh.2020.04.017. Epub 2020 Apr 11.
BACKGROUND & AIMS: Several strategies are available for detecting cirrhosis in patients with nonalcoholic fatty liver disease (NAFLD), but their cost effectiveness is not clear. We developed a decision model to quantify the accuracy and costs of 9 single or combination strategies, including 3 noninvasive tests (fibrosis-4 [FIB-4], vibration-controlled transient elastography [VCTE], and magnetic resonance elastography [MRE]) and liver biopsy, for the detection of cirrhosis in patients with NAFLD.
METHODS
Data on the diagnostic accuracy, costs, adverse events, and cirrhosis outcomes over a 5-year period were obtained from publications. The diagnostic accuracy, per-patient cost per correct diagnosis of cirrhosis, and incremental cost-effectiveness ratios (ICERs) were calculated for each strategy for base cirrhosis prevalence values of 0.27%, 2%, and 4%.
RESULTS
The combination of the FIB-4 and VCTE identified patients with cirrhosis in NAFLD populations with a 0.27%, 2%, and 4% prevalence of cirrhosis with the lowest cost per person ($401, $690, and $1024, respectively) and highest diagnostic accuracy (89.3%, 88.5%, and 87.5% respectively). The combination of FIB-4 and MRE ranked second in cost per person ($491, $781, and $1114, respectively) and diagnostic accuracy (92.4%, 91.6%, 90.6%, respectively). Compared with the combination of FIB-4 and VCTE (least costly), the ICERs were lower for the combination of FIB-4 and MRE ($2864, $2918, and $2921) than the combination of FIB-4 and liver biopsy ($4454, $5156, and $5956) at the cirrhosis prevalence values tested. When the goal was to avoid liver biopsy, FIB-4 + VCTE and FIB-4 + MRE had similar diagnostic accuracies, ranging from 87.5% to 89.3% and 90.6% to 92.4% for a cirrhosis diagnosis, respectively, although FIB-4 + MRE had a slightly higher cost.
CONCLUSIONS
In our cost-effectiveness analysis based on the US health care system, we found that results from FIB-4, followed by either VCTE, MRE, or liver biopsy, detect cirrhosis in patients with NAFLD with a high level of accuracy and low cost. Compared with FIB-4 + VCTE, which was the least costly strategy, FIB-4 + MRE had a lower ICER than FIB-4 + LB.
背景与目的
有多种策略可用于检测非酒精性脂肪性肝病（NAFLD）患者的肝硬化，但它们的成本效益尚不清楚。我们开发了一个决策模型，以量化 9 种单一或联合策略的准确性和成本，包括 3 种非侵入性检测（纤维化 4 指数[FIB-4]、振动控制瞬时弹性成像[VCTE]和磁共振弹性成像[MRE]）和肝活检，用于检测 NAFLD 患者的肝硬化。
方法
从出版物中获得了 5 年内关于诊断准确性、成本、不良事件和肝硬化结局的数据。对于肝硬化患病率分别为 0.27%、2%和 4%的基本情况，计算了每种策略的准确性、每位患者正确诊断肝硬化的成本和增量成本效益比（ICER）。
结果
FIB-4 和 VCTE 的联合使用可在肝硬化患病率为 0.27%、2%和 4%的 NAFLD 人群中识别出肝硬化患者，每人的成本最低（分别为 401 美元、690 美元和 1024 美元），诊断准确性最高（分别为 89.3%、88.5%和 87.5%）。FIB-4 和 MRE 的联合使用在每人的成本方面排名第二（分别为 491 美元、781 美元和 1114 美元），诊断准确性也排名第二（分别为 92.4%、91.6%和 90.6%）。与 FIB-4 和 VCTE 的联合使用（成本最低）相比，FIB-4 和 MRE 的联合使用（ICER 分别为 2864 美元、2918 美元和 2921 美元）在测试的肝硬化患病率下低于 FIB-4 和肝活检的联合使用（ICER 分别为 4454 美元、5156 美元和 5956 美元）。当目标是避免肝活检时，FIB-4+VCTE 和 FIB-4+MRE 的诊断准确性相似，分别为 87.5%至 89.3%和 90.6%至 92.4%，尽管 FIB-4+MRE 的成本略高。
结论
基于美国医疗保健系统，我们的成本效益分析发现，FIB-4 后接 VCTE、MRE 或肝活检可高度准确且低成本地检测 NAFLD 患者的肝硬化。与成本最低的 FIB-4+VCTE 策略相比，FIB-4+MRE 的 ICER 低于 FIB-4+LB。
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