Cost-effectiveness of non-invasive methods for the diagnosis of liver fibrosis in patients with Chronic Hepatitis C in the UK

Abstract: Currently, liver biopsy is considered the reference standard for the diagnosis of liver fibrosis and cirrhosis; however liver biopsy is expensive and associated with a risk of complications, including the risk of significant bleeding. Alternatives to liver biopsy include non-invasive tests (NITs) such as transient elastography and serum markers of fibrosis. These are cheaper and less invasive; however are usually less sensitive and specific than biopsy. In order to make the best use of limited healthcare resources, the cost-effectiveness of the alternative strategies for testing should be established in order to inform decisions about which should be adopted for routine use.

Results of an analysis of the cost-effectiveness of a range of NITs to determine treatment decisions will be presented. Costs have been estimated for a UK National Health Service perspective and health outcomes measured using quality adjusted life years (QALYs). Markov modelling was used to estimate the long term costs and health outcomes for all possible test outcomes and results synthesised with data on test sensitivity and specificity using a decision tree framework. Provisional results of an extension to the analysis, which incorporates data on new treatments for patients with chronic hepatitis C, will also be presented.