Economic evaluation of a community-based diagnostic pathway to stratify adults for non-alcoholic fatty liver disease: a Markov model informed by a feasibility study
Objectives: To assess the long-term cost-effectiveness of a risk stratification pathway, compared with standard care, for detecting non-alcoholic fatty liver disease (NAFLD) in primary care. Setting: Primary care general practices in England. Participants: Adults who have been identified in pr...
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| Format: | Article |
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BMJ Publishing Group Ltd
2017
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| Online Access: | https://eprints.nottingham.ac.uk/42585/ |
| _version_ | 1848796519773241344 |
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| author | Tanajewski, Lukasz Harris, Rebecca Harman, David J. Aithal, Guruprasad P. Card, Timothy R. Gkountouras, Georgios Berdunov, Vladislav Guha, Indra Neil Elliott, Rachel |
| author_facet | Tanajewski, Lukasz Harris, Rebecca Harman, David J. Aithal, Guruprasad P. Card, Timothy R. Gkountouras, Georgios Berdunov, Vladislav Guha, Indra Neil Elliott, Rachel |
| author_sort | Tanajewski, Lukasz |
| building | Nottingham Research Data Repository |
| collection | Online Access |
| description | Objectives: To assess the long-term cost-effectiveness of a risk stratification pathway, compared with standard care, for detecting non-alcoholic fatty liver disease (NAFLD) in primary care.
Setting: Primary care general practices in England.
Participants: Adults who have been identified in primary care to have a risk factor for developing NAFLD, that is, type 2 diabetes without a history of excessive alcohol use.
Intervention: A community-based pathway, which utilises transient elastography and hepatologists to stratify patients at risk of NAFLD, has been implemented and demonstrated to be feasible (NCT02037867). Earlier identification could mean earlier treatments, referral to specialist, and enrolment into surveillance programmes.
Design: The impact of earlier detection and treatment with the risk stratification pathway on progression to later stages of liver disease was examined using decision modelling with Markov chains to estimate lifetime health and economic effects of the two comparators.
Data sources: Data from a prospective cross-sectional feasibility study indicating risk stratification pathway and standard care diagnostic accuracies, were combined with a Markov model that comprised the following states: no/mild liver disease, significant liver disease, compensated cirrhosis; decompensated cirrhosis, hepatocellular carcinoma, liver transplant and death. The model data were chosen from up-to-date UK sources, published literature and an expert panel.
Outcome measure: An incremental cost-effectiveness ratio (ICER) indicating cost per quality adjusted life year (QALY) of the risk stratification pathway compared with standard care was estimated.
Results: The risk stratification pathway was more effective than standard care, and cost ￡2,138 per QALY gained. The ICER was most sensitive to estimates of the rate of fibrosis progression and the effect of treatment on reducing this, and ranged from -￡1,895 to ￡7,032/QALY. The risk stratification pathway demonstrated an 85% probability of cost-effectiveness at the UK willingness-to-pay threshold of ￡20,000/QALY.
Conclusions: Implementation of a community-based risk stratification pathway is likely to be cost effective. |
| first_indexed | 2025-11-14T19:49:17Z |
| format | Article |
| id | nottingham-42585 |
| institution | University of Nottingham Malaysia Campus |
| institution_category | Local University |
| last_indexed | 2025-11-14T19:49:17Z |
| publishDate | 2017 |
| publisher | BMJ Publishing Group Ltd |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | nottingham-425852020-05-04T18:54:09Z https://eprints.nottingham.ac.uk/42585/ Economic evaluation of a community-based diagnostic pathway to stratify adults for non-alcoholic fatty liver disease: a Markov model informed by a feasibility study Tanajewski, Lukasz Harris, Rebecca Harman, David J. Aithal, Guruprasad P. Card, Timothy R. Gkountouras, Georgios Berdunov, Vladislav Guha, Indra Neil Elliott, Rachel Objectives: To assess the long-term cost-effectiveness of a risk stratification pathway, compared with standard care, for detecting non-alcoholic fatty liver disease (NAFLD) in primary care. Setting: Primary care general practices in England. Participants: Adults who have been identified in primary care to have a risk factor for developing NAFLD, that is, type 2 diabetes without a history of excessive alcohol use. Intervention: A community-based pathway, which utilises transient elastography and hepatologists to stratify patients at risk of NAFLD, has been implemented and demonstrated to be feasible (NCT02037867). Earlier identification could mean earlier treatments, referral to specialist, and enrolment into surveillance programmes. Design: The impact of earlier detection and treatment with the risk stratification pathway on progression to later stages of liver disease was examined using decision modelling with Markov chains to estimate lifetime health and economic effects of the two comparators. Data sources: Data from a prospective cross-sectional feasibility study indicating risk stratification pathway and standard care diagnostic accuracies, were combined with a Markov model that comprised the following states: no/mild liver disease, significant liver disease, compensated cirrhosis; decompensated cirrhosis, hepatocellular carcinoma, liver transplant and death. The model data were chosen from up-to-date UK sources, published literature and an expert panel. Outcome measure: An incremental cost-effectiveness ratio (ICER) indicating cost per quality adjusted life year (QALY) of the risk stratification pathway compared with standard care was estimated. Results: The risk stratification pathway was more effective than standard care, and cost ￡2,138 per QALY gained. The ICER was most sensitive to estimates of the rate of fibrosis progression and the effect of treatment on reducing this, and ranged from -￡1,895 to ￡7,032/QALY. The risk stratification pathway demonstrated an 85% probability of cost-effectiveness at the UK willingness-to-pay threshold of ￡20,000/QALY. Conclusions: Implementation of a community-based risk stratification pathway is likely to be cost effective. BMJ Publishing Group Ltd 2017-07-05 Article PeerReviewed Tanajewski, Lukasz, Harris, Rebecca, Harman, David J., Aithal, Guruprasad P., Card, Timothy R., Gkountouras, Georgios, Berdunov, Vladislav, Guha, Indra Neil and Elliott, Rachel (2017) Economic evaluation of a community-based diagnostic pathway to stratify adults for non-alcoholic fatty liver disease: a Markov model informed by a feasibility study. BMJ Open, 7 (6). pp. 1-11. ISSN 2044-6055 Cost effectiveness analysis Screening Transient elastography Fibrosis Quality-adjusted life-years http://bmjopen.bmj.com/content/7/6/e015659 doi:10.1136/bmjopen-2016-015659 doi:10.1136/bmjopen-2016-015659 |
| spellingShingle | Cost effectiveness analysis Screening Transient elastography Fibrosis Quality-adjusted life-years Tanajewski, Lukasz Harris, Rebecca Harman, David J. Aithal, Guruprasad P. Card, Timothy R. Gkountouras, Georgios Berdunov, Vladislav Guha, Indra Neil Elliott, Rachel Economic evaluation of a community-based diagnostic pathway to stratify adults for non-alcoholic fatty liver disease: a Markov model informed by a feasibility study |
| title | Economic evaluation of a community-based diagnostic pathway to stratify adults for non-alcoholic fatty liver disease: a Markov model informed by a feasibility study |
| title_full | Economic evaluation of a community-based diagnostic pathway to stratify adults for non-alcoholic fatty liver disease: a Markov model informed by a feasibility study |
| title_fullStr | Economic evaluation of a community-based diagnostic pathway to stratify adults for non-alcoholic fatty liver disease: a Markov model informed by a feasibility study |
| title_full_unstemmed | Economic evaluation of a community-based diagnostic pathway to stratify adults for non-alcoholic fatty liver disease: a Markov model informed by a feasibility study |
| title_short | Economic evaluation of a community-based diagnostic pathway to stratify adults for non-alcoholic fatty liver disease: a Markov model informed by a feasibility study |
| title_sort | economic evaluation of a community-based diagnostic pathway to stratify adults for non-alcoholic fatty liver disease: a markov model informed by a feasibility study |
| topic | Cost effectiveness analysis Screening Transient elastography Fibrosis Quality-adjusted life-years |
| url | https://eprints.nottingham.ac.uk/42585/ https://eprints.nottingham.ac.uk/42585/ https://eprints.nottingham.ac.uk/42585/ |