ArticleBMC gastroenterology2019
Cost-comparison analysis of FIB-4, ELF and fibroscan in community pathways for non-alcoholic fatty liver disease.
Article in BMC gastroenterology, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 64 papers, 4 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.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
64 citing papers in PubMed, 4 syntheses or guidelines pooled it, 122 citations in OpenAlex.
- KASL clinical practice guidelines for noninvasive tests to assess liver fibrosis in chronic liver disease.Clinical and molecular hepatology · 2024Guideline
- Accuracy of Noninvasive Scoring Systems in Assessing Liver Fibrosis in Patients with Nonalcoholic Fatty Liver Disease: A Systematic Review and Meta-Analysis.Gut and liver · 2022Pooled it
- Non-alcoholic fatty liver disease in adults 2021: A clinical practice guideline of the Italian Association for the Study of the Liver (AISF), the Italian Society of Diabetology (SID) and the Italian Society of Obesity (SIO).Eating and weight disorders : EWD · 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
- 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
- Assessing Venous Congestion in Heart Failure: A Review of Splanchnic, Cardiac, and Pulmonary Ultrasound: Part 2: Contrast-Enhanced Ultrasound and Shear Wave.Journal of clinical medicine · 2026Review
- Noninvasive liver fibrosis assessment in metabolic dysfunction-associated steatotic liver disease.World journal of hepatology · 2026Review
- Assessing the value of fibro scan in the detection of liver fibrosis among patients with sickle cell disease- a single center study.Therapeutic advances in hematology · 2026Article
- Article
- 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 Blood-Based Fibrosis Screening in High-Risk Metabolic Liver Diseases With Emerging Therapies.Gastro hep advances · 2026Article
- Cost Effectiveness of Diagnosis and Screening Methods in Nonalcoholic Fatty Liver Disease: A Systematic Review.International journal of preventive medicine · 2026Review
- Implementation of noninvasive liver disease screening tools in primary care.Korean journal of family medicine · 2025Article
- Reduced Predictive Performance of the FIB-4 Index in Chronic Hepatitis B Patients With Concurrent Metabolic Dysfunction-Associated Liver Disease.Journal of viral hepatitis · 2025Article
- Article
- Liver stiffness measurements in patients with metabolic dysfunction-associated steatotic liver disease: Updates on the method effectiveness and perspectives.World journal of hepatology · 2025Review
- 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
- Observational
- Non-Invasive Tests as a Replacement for Liver Biopsy in the Assessment of MASLD.Medicina (Kaunas, Lithuania) · 2025Review
- Increasing engagement with liver disease management across the UK: a follow-up cross-sectional survey.BJGP open · 2025Article
4 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
12 authors at 5 institutions in 2 countries.
Funding
Abstract
backgroundThe identification of patients with advanced liver fibrosis secondary to non-alcoholic fatty liver disease (NAFLD) remains challenging. Using non-invasive liver fibrosis tests (NILT) in primary care may permit earlier detection of patients with clinically significant disease for specialist review, and reduce unnecessary referral of patients with mild disease. We constructed an analytical model to assess the clinical and cost differentials of such strategies.
methodsA probabilistic decisional model simulated a cohort of 1000 NAFLD patients over 1 year from a healthcare payer perspective. Simulations compared standard care (SC) (scenario 1) to: Scenario 2: FIB-4 for all patients followed by Enhanced Liver Fibrosis (ELF) test for patients with indeterminate FIB-4 results; Scenario 3: FIB-4 followed by fibroscan for indeterminate FIB-4; Scenario 4: ELF alone; and Scenario 5: fibroscan alone. Model estimates were derived from the published literature. The primary outcome was cost per case of advanced fibrosis detected.
resultsIntroduction of NILT increased detection of advanced fibrosis over 1 year by 114, 118, 129 and 137% compared to SC in scenarios 2, 3, 4 and 5 respectively with reduction in unnecessary referrals by 85, 78, 71 and 42% respectively. The cost per case of advanced fibrosis (METAVIR ≥F3) detected was £25,543, £8932, £9083, £9487 and £10,351 in scenarios 1, 2, 3, 4 and 5 respectively. Total budget spend was reduced by 25.2, 22.7, 15.1 and 4.0% in Scenarios 2, 3, 4 and 5 compared to £670 K at baseline.
conclusionOur analyses suggest that the use of NILT in primary care can increases early detection of advanced liver fibrosis and reduce unnecessary referral of patients with mild disease and is cost efficient. Adopting a two-tier approach improves resource utilization.
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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.