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Cost-effectiveness of noninvasive liver fibrosis tests for treatment decisions in patients with chronic hepatitis B in the UK: systematic review and economic evaluation.
Crossan, C; Tsochatzis, E A; Longworth, L; Gurusamy, K; Papastergiou, V; Thalassinos, E; Mantzoukis, K; Rodriguez-Peralvarez, M; O'Brien, J; Noel-Storr, A; Papatheodoridis, G V; Davidson, B; Burroughs, A K.
Afiliación
  • Crossan C; Health Economics Research Group, Brunel University London, London, UK.
  • Tsochatzis EA; Sheila Sherlock Liver Unit and UCL Institute for Liver and Digestive Health, The Royal Free Hospital and UCL, London, UK.
  • Longworth L; Health Economics Research Group, Brunel University London, London, UK.
  • Gurusamy K; Division of Surgery, Royal Free Campus, UCL Medical School, London, UK.
  • Papastergiou V; Health Economics Research Group, Brunel University London, London, UK.
  • Thalassinos E; Health Economics Research Group, Brunel University London, London, UK.
  • Mantzoukis K; Health Economics Research Group, Brunel University London, London, UK.
  • Rodriguez-Peralvarez M; Health Economics Research Group, Brunel University London, London, UK.
  • O'Brien J; Health Economics Research Group, Brunel University London, London, UK.
  • Noel-Storr A; Cochrane Dementia and Cognitive Improvement Group, Nuffield Department of Medicine, Oxford University, Oxford, UK.
  • Papatheodoridis GV; Laiko Hospital, University Department of Gastroenterology, Athens, Greece.
  • Davidson B; Division of Surgery, Royal Free Campus, UCL Medical School, London, UK.
  • Burroughs AK; Sheila Sherlock Liver Unit and UCL Institute for Liver and Digestive Health, The Royal Free Hospital and UCL, London, UK.
J Viral Hepat ; 23(2): 139-49, 2016 Feb.
Article en En | MEDLINE | ID: mdl-26444996
We compared the cost-effectiveness of various noninvasive tests (NITs) in patients with chronic hepatitis B and elevated transaminases and/or viral load who would normally undergo liver biopsy to inform treatment decisions. We searched various databases until April 2012. 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 decision-making strategies: testing with NITs and treating patients with fibrosis stage ≥F2, testing with liver biopsy and treating patients with ≥F2, treat none (watchful waiting) and treat all irrespective of fibrosis. Treating all patients without prior fibrosis assessment had an incremental cost-effectiveness ratio (ICER) of £28,137 per additional QALY gained for HBeAg-negative patients. For HBeAg-positive patients, using Fibroscan was the most cost-effective option with an ICER of £23,345. The base case results remained robust in the majority of sensitivity analyses, but were sensitive to changes in the ≥ F2 prevalence and the benefit of treatment in patients with F0-F1. For HBeAg-negative patients, strategies excluding NITs were the most cost-effective: treating all patients regardless of fibrosis level if the high cost-effectiveness threshold of £30,000 is accepted; watchful waiting if not. For HBeAg-positive patients, using Fibroscan to identify and treat those with ≥F2 was the most cost-effective option.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Costos de la Atención en Salud / Análisis Costo-Beneficio / Pruebas Diagnósticas de Rutina / Cirrosis Hepática Tipo de estudio: Diagnostic_studies / Health_economic_evaluation / Prognostic_studies / Risk_factors_studies / Systematic_reviews Aspecto: Patient_preference Límite: Humans País/Región como asunto: Europa Idioma: En Revista: J Viral Hepat Asunto de la revista: GASTROENTEROLOGIA Año: 2016 Tipo del documento: Article Pais de publicación: Reino Unido
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Costos de la Atención en Salud / Análisis Costo-Beneficio / Pruebas Diagnósticas de Rutina / Cirrosis Hepática Tipo de estudio: Diagnostic_studies / Health_economic_evaluation / Prognostic_studies / Risk_factors_studies / Systematic_reviews Aspecto: Patient_preference Límite: Humans País/Región como asunto: Europa Idioma: En Revista: J Viral Hepat Asunto de la revista: GASTROENTEROLOGIA Año: 2016 Tipo del documento: Article Pais de publicación: Reino Unido