Cost Effectiveness of Fibrosis Assessment Prior to Treatment for Chronic Hepatitis C Patients

Shan Liu^1*, Michaël Schwarzinger², Fabrice Carrat³, Jeremy D. Goldhaber-Fiebert⁴

1 Department of Management Science and Engineering, Stanford University, Stanford, California, United States of America, 2 Equipe ATIP-AVENIR/UMR-S 738 INSERM, Paris Diderot University, Paris, France, 3 UMR-S 707 INSERM, Pierre et Marie Curie University, Paris, France, 4 Department of Medicine, Center for Health Policy and Center for Primary Care and Outcomes Research, Stanford University, Stanford, California, United States of America

Abstract

Background and Aims

Chronic hepatitis C (HCV) is a liver disease affecting over 3 million Americans. Liver biopsy is the gold standard for assessing liver fibrosis and is used as a benchmark for initiating treatment, though it is expensive and carries risks of complications. FibroTest is a non-invasive biomarker assay for fibrosis, proposed as a screening alternative to biopsy.

Methods

We assessed the cost-effectiveness of FibroTest and liver biopsy used alone or sequentially for six strategies followed by treatment of eligible U.S. patients: FibroTest only; FibroTest with liver biopsy for ambiguous results; FibroTest followed by biopsy to rule in; or to rule out significant fibrosis; biopsy only (recommended practice); and treatment without screening. We developed a Markov model of chronic HCV that tracks fibrosis progression. Outcomes were expressed as expected lifetime costs (2009 USD), quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICER).

Results

Treatment of chronic HCV without fibrosis screening is preferred for both men and women. For genotype 1 patients treated with pegylated interferon and ribavirin, the ICERs are $5,400/QALY (men) and $6,300/QALY (women) compared to FibroTest only; the ICERs increase to $27,200/QALY (men) and $30,000/QALY (women) with the addition of telaprevir. For genotypes 2 and 3, treatment is more effective and less costly than all alternatives. In clinical settings where testing is required prior to treatment, FibroTest only is more effective and less costly than liver biopsy. These results are robust to multi-way and probabilistic sensitivity analyses.

Conclusions

Early treatment of chronic HCV is superior to the other fibrosis screening strategies. In clinical settings where testing is required, FibroTest screening is a cost-effective alternative to liver biopsy.

Citation: Liu S, Schwarzinger M, Carrat F, Goldhaber-Fiebert JD (2011) Cost Effectiveness of Fibrosis Assessment Prior to Treatment for Chronic Hepatitis C Patients. PLoS ONE 6(12): e26783. doi:10.1371/journal.pone.0026783

Editor: Ravi Jhaveri, Duke University School of Medicine, United States of America

Received: June 27, 2011; Accepted: October 4, 2011; Published: December 2, 2011

Copyright: © 2011 Liu et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Funding: Ms. Liu was supported by a Stanford Graduate Fellowship. Dr. Goldhaber-Fiebert was supported in part by a U.S. National Institutes of Health National Institute on Aging Career Development Award (K01 AG037593-01A1: PI; Goldhaber-Fiebert). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.

* E-mail: shanliu@stanford.edu

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