Cost effectiveness of fibrosis assessment prior to treatment for chronic hepatitis C patients.

<h4>Background and aims</h4>Chronic hepatitis C (HCV) is a liver disease affecting over 3 million Americans. Liver biopsy is the gold standard for assessing liver fibrosis and is used as a benchmark for initiating treatment, though it is expensive and carries risks of complications. Fibr...

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Autores principales:	Shan Liu, Michaël Schwarzinger, Fabrice Carrat, Jeremy D Goldhaber-Fiebert
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2011
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/cee6a3f304084a5b9154e1af5ab1e793
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spelling	oai:doaj.org-article:cee6a3f304084a5b9154e1af5ab1e7932021-12-02T20:11:42ZCost effectiveness of fibrosis assessment prior to treatment for chronic hepatitis C patients.1932-620310.1371/journal.pone.0026783https://doaj.org/article/cee6a3f304084a5b9154e1af5ab1e7932011-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/22164204/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background and aims</h4>Chronic hepatitis C (HCV) is a liver disease affecting over 3 million Americans. Liver biopsy is the gold standard for assessing liver fibrosis and is used as a benchmark for initiating treatment, though it is expensive and carries risks of complications. FibroTest is a non-invasive biomarker assay for fibrosis, proposed as a screening alternative to biopsy.<h4>Methods</h4>We assessed the cost-effectiveness of FibroTest and liver biopsy used alone or sequentially for six strategies followed by treatment of eligible U.S. patients: FibroTest only; FibroTest with liver biopsy for ambiguous results; FibroTest followed by biopsy to rule in; or to rule out significant fibrosis; biopsy only (recommended practice); and treatment without screening. We developed a Markov model of chronic HCV that tracks fibrosis progression. Outcomes were expressed as expected lifetime costs (2009 USD), quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICER).<h4>Results</h4>Treatment of chronic HCV without fibrosis screening is preferred for both men and women. For genotype 1 patients treated with pegylated interferon and ribavirin, the ICERs are $5,400/QALY (men) and $6,300/QALY (women) compared to FibroTest only; the ICERs increase to $27,200/QALY (men) and $30,000/QALY (women) with the addition of telaprevir. For genotypes 2 and 3, treatment is more effective and less costly than all alternatives. In clinical settings where testing is required prior to treatment, FibroTest only is more effective and less costly than liver biopsy. These results are robust to multi-way and probabilistic sensitivity analyses.<h4>Conclusions</h4>Early treatment of chronic HCV is superior to the other fibrosis screening strategies. In clinical settings where testing is required, FibroTest screening is a cost-effective alternative to liver biopsy.Shan LiuMichaël SchwarzingerFabrice CarratJeremy D Goldhaber-FiebertPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 6, Iss 12, p e26783 (2011)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Shan Liu Michaël Schwarzinger Fabrice Carrat Jeremy D Goldhaber-Fiebert Cost effectiveness of fibrosis assessment prior to treatment for chronic hepatitis C patients.
description	<h4>Background and aims</h4>Chronic hepatitis C (HCV) is a liver disease affecting over 3 million Americans. Liver biopsy is the gold standard for assessing liver fibrosis and is used as a benchmark for initiating treatment, though it is expensive and carries risks of complications. FibroTest is a non-invasive biomarker assay for fibrosis, proposed as a screening alternative to biopsy.<h4>Methods</h4>We assessed the cost-effectiveness of FibroTest and liver biopsy used alone or sequentially for six strategies followed by treatment of eligible U.S. patients: FibroTest only; FibroTest with liver biopsy for ambiguous results; FibroTest followed by biopsy to rule in; or to rule out significant fibrosis; biopsy only (recommended practice); and treatment without screening. We developed a Markov model of chronic HCV that tracks fibrosis progression. Outcomes were expressed as expected lifetime costs (2009 USD), quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICER).<h4>Results</h4>Treatment of chronic HCV without fibrosis screening is preferred for both men and women. For genotype 1 patients treated with pegylated interferon and ribavirin, the ICERs are $5,400/QALY (men) and $6,300/QALY (women) compared to FibroTest only; the ICERs increase to $27,200/QALY (men) and $30,000/QALY (women) with the addition of telaprevir. For genotypes 2 and 3, treatment is more effective and less costly than all alternatives. In clinical settings where testing is required prior to treatment, FibroTest only is more effective and less costly than liver biopsy. These results are robust to multi-way and probabilistic sensitivity analyses.<h4>Conclusions</h4>Early treatment of chronic HCV is superior to the other fibrosis screening strategies. In clinical settings where testing is required, FibroTest screening is a cost-effective alternative to liver biopsy.
format	article
author	Shan Liu Michaël Schwarzinger Fabrice Carrat Jeremy D Goldhaber-Fiebert
author_facet	Shan Liu Michaël Schwarzinger Fabrice Carrat Jeremy D Goldhaber-Fiebert
author_sort	Shan Liu
title	Cost effectiveness of fibrosis assessment prior to treatment for chronic hepatitis C patients.
title_short	Cost effectiveness of fibrosis assessment prior to treatment for chronic hepatitis C patients.
title_full	Cost effectiveness of fibrosis assessment prior to treatment for chronic hepatitis C patients.
title_fullStr	Cost effectiveness of fibrosis assessment prior to treatment for chronic hepatitis C patients.
title_full_unstemmed	Cost effectiveness of fibrosis assessment prior to treatment for chronic hepatitis C patients.
title_sort	cost effectiveness of fibrosis assessment prior to treatment for chronic hepatitis c patients.
publisher	Public Library of Science (PLoS)
publishDate	2011
url	https://doaj.org/article/cee6a3f304084a5b9154e1af5ab1e793
work_keys_str_mv	AT shanliu costeffectivenessoffibrosisassessmentpriortotreatmentforchronichepatitiscpatients AT michaelschwarzinger costeffectivenessoffibrosisassessmentpriortotreatmentforchronichepatitiscpatients AT fabricecarrat costeffectivenessoffibrosisassessmentpriortotreatmentforchronichepatitiscpatients AT jeremydgoldhaberfiebert costeffectivenessoffibrosisassessmentpriortotreatmentforchronichepatitiscpatients
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Cost effectiveness of fibrosis assessment prior to treatment for chronic hepatitis C patients.

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