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Cost Effectiveness of Fibrosis Assessment Prior to Treatment for Chronic Hepatitis C Patients

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  • Shan Liu
  • Michaël Schwarzinger
  • Fabrice Carrat
  • Jeremy D Goldhaber-Fiebert

Abstract

Background and Aims: 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. Methods: 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). Results: 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. Conclusions: 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.

Suggested Citation

  • Shan Liu & Michaël Schwarzinger & Fabrice Carrat & Jeremy D Goldhaber-Fiebert, 2011. "Cost Effectiveness of Fibrosis Assessment Prior to Treatment for Chronic Hepatitis C Patients," PLOS ONE, Public Library of Science, vol. 6(12), pages 1-14, December.
    • Handle: RePEc:plo:pone00:0026783
    DOI: 10.1371/journal.pone.0026783
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    References listed on IDEAS

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    1. Patrick W. Sullivan & Vahram Ghushchyan, 2006. "Preference-Based EQ-5D Index Scores for Chronic Conditions in the United States," Medical Decision Making, , vol. 26(4), pages 410-420, July.
    2. David J. McLernon & John Dillon & Peter T. Donnan, 2008. "Systematic Review: Health-State Utilities in Liver Disease: A Systematic Review," Medical Decision Making, , vol. 28(4), pages 582-592, July.
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    Cited by:

    1. Ting-Yu Ho & Shan Liu & Zelda B. Zabinsky, 2019. "A Multi-Fidelity Rollout Algorithm for Dynamic Resource Allocation in Population Disease Management," Health Care Management Science, Springer, vol. 22(4), pages 727-755, December.
    2. Anita J Brogan & Sandra E Talbird & James R Thompson & Jeffrey D Miller & Jaime Rubin & Baris Deniz, 2014. "Cost-effectiveness of Telaprevir Combination Therapy for Chronic Hepatitis C," PLOS ONE, Public Library of Science, vol. 9(3), pages 1-11, March.
    3. Roy Lothan & Noa Gutman & Dan Yamin, 2022. "Country versus pharmaceutical company interests for hepatitis C treatment," Health Care Management Science, Springer, vol. 25(4), pages 725-749, December.
    4. Shan Liu & Lauren E Cipriano & Mark Holodniy & Jeremy D Goldhaber-Fiebert, 2013. "Cost-Effectiveness Analysis of Risk-Factor Guided and Birth-Cohort Screening for Chronic Hepatitis C Infection in the United States," PLOS ONE, Public Library of Science, vol. 8(3), pages 1-14, March.

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