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research
Cost-effectiveness of noninvasive liver fibrosis tests for treatment decisions in patients with chronic hepatitis C
Authors
AK Burroughs
C Crossan
+10 more
B Davidson
K Gurusamy
L Longworth
K Mantzoukis
A Noel-Storr
J O'Brien
V Papastergiou
M Rodriguez-Peralvarez
E Thalassinos
EA Tsochatzis
Publication date
1 January 2014
Publisher
'Wiley'
Doi
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on
PubMed
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. © 2014 The Authors
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UCL Discovery
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oai:eprints.ucl.ac.uk.OAI2:143...
Last time updated on 22/10/2014
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Brunel University Research Archive
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oai:bura.brunel.ac.uk:2438/100...
Last time updated on 18/05/2015