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NAFLD fibrosis score most cost-effective method for diagnosing fibrosis risk

The NAFLD fibrosis score test was found to be the most dominant and cost-effective method for measuring risk of fibrosis among older adults with nonalcoholic fatty liver disease, according to new study data.

Researchers, including Elliot B. Tapper, MD, division of gastroenterology/hepatology, department of medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, developed and used a probabilistic decision analytical microsimulation state-transition model to analyze the cost-effectiveness of four strategies used to determine fibrosis risk in 10,000 patients who were aged 50 years with NAFLD: vibration controlled transient elastography (VCTE), the NAFLD fibrosis score (NFS), combination testing with NFS and VCTE, and liver biopsy. The VCTE was used among a prospective cohort of 144 patients with NAFLD.

Elliot B. Tapper

“What sets NAFLD apart from other common liver diseases is its lack of a definite therapeutic modality,” the researchers wrote. “In this context, a major focus of clinical care for patients with NAFLD is discerning those at highest risk for the complications of advanced liver disease. … The cost-effectiveness of this practice is in question.”

Overall, the researchers concluded from the analyses that NFS alone and the NFS/VCTE strategies were the most dominant and cost-effective strategies, with the NFS costing $5,795 and NFS/VCTE costing $5,768 per quality-adjusted life years (QALY). The average cost and benefit per person from the NFS strategy is $82,472 and 14.42 QALY. The NFS alone strategy created a 0.04 increase in QALY for an additional $1,323 per person.

Over the course of 1 year of care, NFS alone created a 0.04 incremental QALY with a cost savings of $2,696 compared with usual care “based on the greatest reduction in liver biopsies,” according to the study. The combined NFS/VCTE strategy created an incremental 0.02 QALY for a cost savings of $2,274.

In the microsimulation, the NFS alone and NFS/VCTE strategies were the most cost-effective in 66.8% and 33.2% of samples given a willingness-to-pay threshold of $100,000 per QALY, according to the research.

Results of a sensitivity analysis showed “the minimum cost per liver biopsy at which the NFS is cost saving is $339 and the maximum cost per VCTE exam at which the NFS/VCTE strategy remains cost saving is $1,593,” according to the study.

“Given the sheer volume of patients with NAFLD as well as the costs of and patient preference to avoid liver biopsy, there is a critical need for noninvasive risk-stratification strategies to improve the identification of patients with advanced liver disease in a cost-effective manner,” the researchers wrote. “In this study of four strategies for the risk stratification of patients with NAFLD, the use of NFS alone was the most cost-effective strategy followed by the combination of NFS with VCTE.”

The researchers concluded: “This approach efficiently and cost-effectively stratifies patients into low- and high-risk categories, which facilitate cost-effective care by avoiding biopsy and the need for specialist follow-up. The cost-effectiveness of these strategies should be repeated after further research elucidates the predictors of NAFLD progression and the benefits of therapy.” – by Melinda Stevens

Disclosures: The researchers report no relevant financial disclosures.