Observational studyBMJ open2017
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.
Observational study in BMJ open, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02037867 (The Stratification of Liver Disease in the Community Using Fibrosis Biomarkers), which is not on this map. Cited by 38 papers, 3 of them syntheses that pooled 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.
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.
The Stratification of Liver Disease in the Community Using Fibrosis Biomarkers
Who cites it
38 citing papers in PubMed, 3 syntheses or guidelines pooled it, 68 citations in OpenAlex.
- AGA Clinical Practice Update: Diagnosis and Management of Nonalcoholic Fatty Liver Disease in Lean Individuals: Expert Review.Gastroenterology · 2022Guideline
- Systematic Literature Review and Critical Appraisal of Health Economic Models Used in Cost-Effectiveness Analyses in Non-Alcoholic Steatohepatitis: Potential for Improvements.PharmacoEconomics · 2020Pooled it
- Pooled it
- EXPLICIT: a feasibility study of remote expert elicitation in health technology assessment.BMC medical informatics and decision making · 2017Trial
- Large Language Models for Diagnosis and Prognosis of Chronic Liver Diseases: A Systematic Review.Health science reports · 2026Review
- Care Pathways for Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD): A State-of-The-Art Review.Liver international : official journal of the International Association for the Study of the Liver · 2026Review
- Proactive case-finding and risk-stratification in people at risk of chronic liver disease in Greater Manchester: a cost-effectiveness analysis.BMJ public health · 2026Article
- Cost Effectiveness of Diagnosis and Screening Methods in Nonalcoholic Fatty Liver Disease: A Systematic Review.International journal of preventive medicine · 2026Review
- Call to action: integrating steatotic liver disease into public health strategies in Canada.Lancet regional health. Americas · 2025Review
- Barriers and facilitators to liver fibrosis screening: Perspectives and practices of Canadian primary care physicians.Canadian liver journal · 2025Article
- Cost-effectiveness analysis of MASLD screening using FIB-4 based two-step algorithm in the medical check-up.Scientific reports · 2025Article
- The Use of Non-i nvasive Biomarkers to Screen for Advanced Fibrosis Associated with Metabolic Dysfunction-associated Steatotic Liver Disease in People with Type 2 Diabetes: A Narrative Review.TouchREVIEWS in endocrinology · 2025Review
- Increasing engagement with liver disease management across the UK: a follow-up cross-sectional survey.BJGP open · 2025Article
- Screening to identify people with type 2 diabetes at risk of liver cancer in primary care: a randomised controlled trial protocol.BMJ open · 2025Article
- Using Panel Management to Identify Adult Patients With High-Risk Metabolic Dysfunction-Associated Steatotic Liver Disease/Metabolic Dysfunction-Associated Steatohepatitis Fibrosis in a Primary Care Clinic: A Pilot Study.The Permanente journal · 2024Article
- Population screening for cirrhosis.Hepatology communications · 2024Review
- Screening for liver fibrosis: lessons from colorectal and lung cancer screening.Nature reviews. Gastroenterology & hepatology · 2024Review
- Article
- Healthcare and socioeconomic costs of NAFLD: A global framework to navigate the uncertainties.Journal of hepatology · 2023Review
- Screening for NAFLD-Current Knowledge and Challenges.Metabolites · 2023Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
9 authors at 4 institutions in 2 countries.
Funding
Abstract
objectivesTo 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.
settingPrimary care general practices in England.
participantsAdults 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.
interventionA community-based pathway, which uses 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.
designThe 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.
resultsThe risk stratification pathway was more effective than standard care and costs £2138 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 -£1895 to £7032/QALY. The risk stratification pathway demonstrated an 85% probability of cost-effectiveness at the UK willingness-to-pay threshold of £20 000/QALY.
conclusionsImplementation of a community-based risk stratification pathway is likely to be cost-effective. TRIAL REGISTRATION NUMBER: NCT02037867, ClinicalTrials.gov.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
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.