Transient elastography for the diagnosis of liver fibrosis: a systematic review of economic evaluations

Sasha van Katwyk; Doug Coyle; Curtis Cooper; Kusala Pussegoda; Chris Cameron; Becky Skidmore; Stacey Brener; David Moher; Kednapa Thavorn

doi:10.1111/liv.13260

Transient elastography for the diagnosis of liver fibrosis: a systematic review of economic evaluations

Liver Int. 2017 Jun;37(6):851-861. doi: 10.1111/liv.13260. Epub 2016 Oct 24.

Authors

Sasha van Katwyk¹, Doug Coyle^{2

3}, Curtis Cooper^{1

4

5}, Kusala Pussegoda¹, Chris Cameron⁶, Becky Skidmore¹, Stacey Brener⁷, David Moher^{1

2}, Kednapa Thavorn^{1

2

8}

Affiliations

¹ Clinical Epidemiology Program, The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada.
² School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada.
³ Health Economics Research Group, Brunel University London, Uxbridge, UK.
⁴ Ottawa Hospital and Regional Hepatitis Program, The Ottawa Hospital, Ottawa, ON, Canada.
⁵ Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
⁶ Evidence Synthesis Group, Cornerstone Research Group, Burlington, ON, Canada.
⁷ Health Quality Ontario, Toronto, ON, Canada.
⁸ Institute of Clinical and Evaluative Sciences (ICES Ottawa), Ottawa, ON, Canada.

PMID: 27699993
DOI: 10.1111/liv.13260

Abstract

Background: Liver biopsy remains the gold standard for the diagnosis of liver fibrosis, but its use as a diagnostic tool is limited by its invasive nature and high cost.

Objective: The aim of this study was to systematically review the cost-effectiveness of transient elastography (TE) with and without controlled attenuation parameter (CAP) for the diagnosis of liver fibrosis or steatosis in patients with hepatitis B, hepatitis C, alcoholic liver disease and non-alcoholic fatty liver disease.

Methods: An economic literature search was performed. Eligibility criteria included systematic reviews, health technology assessments or economic evaluations of TE compared to liver biopsy and other non-invasive tests. After abstract screening, full-text reports of potentially relevant articles were assessed in duplicate. The methodological quality of the included studies was also appraised.

Results: The database search yielded 253 records; four cost-effectiveness and four cost-utility studies were included. The methodological quality of the included studies varies. High-quality cost-effectiveness studies not only suggested that TE is less costly but also less accurate than liver biopsy. The incremental cost-effectiveness ratio (ICER) of TE improves with a greater level of diagnostic accuracy and a higher degree of liver fibrosis. High-quality cost-utility studies indicated that TE is a cost-effective alternative to biopsy with ICER between $9000 and $14 000 per QALY for patients with hepatitis C. We did not find studies that assessed the cost-effectiveness of TE with CAP for the diagnosis of liver steatosis.

Conclusions: Transient elastography is an economically attractive alternative to liver biopsy and other non-invasive diagnostic tests especially for patients with a higher degree of liver fibrosis.

Keywords: chronic liver disease; controlled attenuation parameter; health economic evaluation; liver fibrosis/steatosis; systematic review; transient elastography.

Publication types

Review
Systematic Review

MeSH terms

Biopsy / economics
Cost-Benefit Analysis*
Elasticity Imaging Techniques / economics*
Hepatitis B / complications
Hepatitis C / complications
Humans
Liver Cirrhosis / diagnostic imaging*
Liver Cirrhosis / pathology
Liver Diseases, Alcoholic / complications
Non-alcoholic Fatty Liver Disease / complications