Evidence map›Paper›PMID 26444996›Full record

SynthesisJournal of viral hepatitis2016

Cost-effectiveness of noninvasive liver fibrosis tests for treatment decisions in patients with chronic hepatitis B in the UK: systematic review and economic evaluation.

C Crossan, E A Tsochatzis, L Longworth, K Gurusamy, V Papastergiou, E Thalassinos, K Mantzoukis, M Rodriguez-Peralvarez, J O'Brien, A Noel-Storr and 3 more

Abstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Journal of viral hepatitis, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers.

0numbers the graph read from it
0cells of the map it votes in
13citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

13 citing papers in PubMed.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors.

C CrossanHealth Economics Research Group, Brunel University London, London, UK.
E A TsochatzisSheila Sherlock Liver Unit and UCL Institute for Liver and Digestive Health, The Royal Free Hospital and UCL, London, UK.
L LongworthHealth Economics Research Group, Brunel University London, London, UK.
K GurusamyDivision of Surgery, Royal Free Campus, UCL Medical School, London, UK.
V PapastergiouHealth Economics Research Group, Brunel University London, London, UK.
E ThalassinosHealth Economics Research Group, Brunel University London, London, UK.
K MantzoukisHealth Economics Research Group, Brunel University London, London, UK.
M Rodriguez-PeralvarezHealth Economics Research Group, Brunel University London, London, UK.
J O'BrienHealth Economics Research Group, Brunel University London, London, UK.
A Noel-StorrCochrane Dementia and Cognitive Improvement Group, Nuffield Department of Medicine, Oxford University, Oxford, UK.
G V PapatheodoridisLaiko Hospital, University Department of Gastroenterology, Athens, Greece.
B DavidsonDivision of Surgery, Royal Free Campus, UCL Medical School, London, UK.
A K BurroughsSheila Sherlock Liver Unit and UCL Institute for Liver and Digestive Health, The Royal Free Hospital and UCL, London, UK.

Funding

Department of Health 09/114/02
6 · The paper itself

Abstract

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.

Indexed as

Cost-Benefit AnalysisHealth Care CostsAntiviral AgentsDiagnostic ErrorsDiagnostic Tests, RoutineHepatitis B, ChronicHepatitis B e AntigensHumansLiver CirrhosisQuality-Adjusted Life YearsUnited KingdomViral LoadAntiviral AgentsHepatitis B e Antigenscirrhosisfibroscanfibrosisincremental cost-effectiveness ratioprognosisquality-adjusted-life-years

Identifiers

PMID26444996
PMCPMC5132027

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.