Siemens Medical Solutions USA Inc., Malvern, Pennsylvania, USA.
Department of Radiology, VA Palo Alto Healthcare System California, USA.
Hepatology. 2023 May 1;77(5):1702-1711. doi: 10.1097/HEP.0000000000000262. Epub 2023 Jan 3.
NAFLD is a common cause of liver disease. To determine the optimal testing strategy for NAFLD patients with advanced fibrosis, several factors such as diagnostic accuracy, failure rates, costs of examinations, and potential treatment options need to be considered. The purpose of this study was to determine the cost-effectiveness of combination testing involving vibration-controlled transient elastography (VCTE) versus magnetic resonance elastography (MRE) as a frontline imaging strategy for NAFLD patients with advanced fibrosis.
A Markov model was developed from the US perspective. The base-case scenario in this model included patients aged 50 years with a Fibrosis-4 score of ≥2.67 and suspected advanced fibrosis. The model included a decision tree and a Markov state-transition model including 5 health states: fibrosis stage 1-2, advanced fibrosis, compensated cirrhosis, decompensated cirrhosis, and death. Both deterministic and probabilistic sensitivity analyses were performed.
Staging fibrosis with MRE cost $8388 more than VCTE but led to an additional 1.19 Quality-adjusted life years (QALYs) with the incremental cost-effectiveness ratio of $7048/QALY. The cost-effectiveness analysis of the 5 strategies revealed that MRE+biopsy and VCTE+MRE+biopsy were the most cost-effective with the incremental cost-effectiveness ratios of $8054/QALY and $8241/QALY, respectively. Furthermore, sensitivity analyses indicated that MRE remained cost-effective with a sensitivity of ≥0.77, whereas VCTE became cost-effective with a sensitivity of ≥0.82.
MRE was not only cost-effective than VCTE as the frontline modality for staging NAFLD patients with Fibrosis-4 ≥2.67 with incremental cost-effectiveness ratio of $7048/QALY but also remained cost-effective when used as a follow-up in instances of VCTE failure to diagnose.
非酒精性脂肪性肝病（NAFLD）是一种常见的肝病。为了确定有晚期纤维化的 NAFLD 患者的最佳检测策略，需要考虑多个因素，如诊断准确性、失败率、检查成本和潜在的治疗选择。本研究旨在确定振动控制瞬时弹性成像（VCTE）与磁共振弹性成像（MRE）联合检测作为有晚期纤维化的 NAFLD 患者一线影像学策略的成本效益。
从美国的角度建立了一个马尔可夫模型。该模型的基本情况包括年龄为 50 岁、Fibrosis-4 评分≥2.67、疑似晚期纤维化的患者。模型包括决策树和马尔可夫状态转移模型，包括 5 个健康状态：纤维化 1-2 期、晚期纤维化、代偿性肝硬化、失代偿性肝硬化和死亡。进行了确定性和概率敏感性分析。
MRE 分期纤维化比 VCTE 多花费 8388 美元，但增加了 1.19 个质量调整生命年（QALY），增量成本效益比为 7048 美元/QALY。对 5 种策略的成本效益分析表明，MRE+活检和 VCTE+MRE+活检是最具成本效益的，增量成本效益比分别为 8054 美元/QALY 和 8241 美元/QALY。此外，敏感性分析表明，MRE 在灵敏度≥0.77 时仍然具有成本效益，而 VCTE 在灵敏度≥0.82 时具有成本效益。
MRE 不仅作为 Fibrosis-4≥2.67 的 NAFLD 患者分期的一线方式比 VCTE 更具成本效益，增量成本效益比为 7048 美元/QALY，而且在 VCTE 无法诊断时作为后续检测也具有成本效益。
