ArticlePloS one2021
Modelling the cost effectiveness of non-alcoholic fatty liver disease risk stratification strategies in the community setting.
Article in PloS one, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 24 papers, 2 of them syntheses that pooled it.
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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.
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Who cites it
24 citing papers in PubMed, 2 syntheses or guidelines pooled it, 29 citations in OpenAlex.
- Diagnostic accuracy of two-dimensional shear wave elastography and point shear wave elastography in identifying different stages of liver fibrosis in patients with metabolic dysfunction-associated steatotic liver disease: A meta-analysis.Biomolecules & biomedicine · 2025Pooled it
- KASL clinical practice guidelines for noninvasive tests to assess liver fibrosis in chronic liver disease.Clinical and molecular hepatology · 2024Guideline
- Summary of Guidelines for Identifying and Risk-Stratifying Patients with Metabolic Dysfunction-Associated Steatotic Liver Disease: A Primer for Family Physicians.Diagnostics (Basel, Switzerland) · 2026Review
- Diabetes and obesity reduce FIB-4 accuracy in MASLD referral pathways.JHEP reports : innovation in hepatology · 2026Article
- Overcoming the barriers in the screening, diagnosis, and follow-up of patients with metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic dysfunction-associated steatohepatitis (MASH).Reviews in endocrine & metabolic disorders · 2026Review
- Imaging Evaluation for Steatotic Liver Disease.Korean journal of radiology · 2026Review
- Article
- Phenotype-driven management in ileocecal Crohn's disease: a narrative review with a proposed research framework.Therapeutic advances in gastroenterology · 2026Review
- Cost Effectiveness of Diagnosis and Screening Methods in Nonalcoholic Fatty Liver Disease: A Systematic Review.International journal of preventive medicine · 2026Review
- A review of multidisciplinary care in metabolic dysfunction-associated steatohepatitis and cardiometabolic disease, with a focus on Canada.Diabetes, obesity & metabolism · 2025Review
- Screening of advanced fibrosis and metabolic dysfunction-associated steatotic liver disease using transient elastography in vulnerable population.Scientific reports · 2025Article
- Assessment of metabolic dysfunction-associated fatty liver disease in primary care: a consensus statement summary.The Medical journal of Australia · 2025Article
- Non-Invasive Tests as a Replacement for Liver Biopsy in the Assessment of MASLD.Medicina (Kaunas, Lithuania) · 2025Review
- Getting persuasive about the non-invasive: assessing liver fibrosis in practice-without a biopsy.Hepatobiliary surgery and nutrition · 2024Article
- Early screening for chronic liver disease: impact of a FIB-4 first integrated care pathway to identify patients with significant fibrosis.Scientific reports · 2024Article
- Poor Performance of Non-invasive Tests for Advanced Fibrosis in Nonalcoholic Fatty Liver Disease: A Multicentric Asian Study.Digestive diseases and sciences · 2023Article
- Diagnosis of esophageal varices by liver stiffness and serum biomarkers in virus-related compensated advanced chronic liver disease.Canadian liver journal · 2023Article
- Identifying Patients with Nonalcoholic Fatty Liver Disease in Primary Care: How and for What Benefit?Journal of clinical medicine · 2023Review
- Screening for NAFLD-Current Knowledge and Challenges.Metabolites · 2023Review
- Screening for Liver Fibrosis in the General Population: Where Do We Stand in 2022?Diagnostics (Basel, Switzerland) · 2022Review
Corrections and comments
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Authors and funding
3 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundNon-alcoholic fatty liver disease (NAFLD) is highly prevalent worldwide. Identifying high-risk patients is critical to best utilize limited health care resources. We established a community-based care pathway using 2D ultrasound shear wave elastography (SWE) to identify high risk patients with NAFLD. Our objective was to assess the cost-effectiveness of various non-invasive strategies to correctly identify high-risk patients.
methodsA decision-analytic model was created using a payer's perspective for a hypothetical patient with NAFLD. FIB-4 [≥1.3], NAFLD fibrosis score (NFS) [≥-1.455], SWE [≥8 kPa], transient elastography (TE) [≥8 kPa], and sequential strategies with FIB-4 or NFS followed by either SWE or TE were compared to identify patients with either significant (≥F2) or advanced fibrosis (≥F3). Model inputs were obtained from local data and published literature. The cost/correct diagnosis of advanced NAFLD was obtained and univariate sensitivity analysis was performed.
resultsFor ≥F2 fibrosis, FIB-4/SWE cost $148.75/correct diagnosis while SWE cost $276.42/correct diagnosis, identifying 84% of patients correctly. For ≥F3 fibrosis, using FIB-4/SWE correctly identified 92% of diagnoses and dominated all other strategies. The ranking of strategies was unchanged when stratified by normal or abnormal ALT. For ≥F3 fibrosis, the cost/correct diagnosis was less in the normal ALT group.
conclusionsSWE based strategies were the most cost effective for diagnosing ≥F2 fibrosis. For ≥F3 fibrosis, FIB-4 followed by SWE was the most effective and least costly strategy. Further evaluation of the timing of repeating non-invasive strategies are required to enhance the cost-effective management of NAFLD.
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