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Publication Detail
Cost-effectiveness analysis of a non-invasive screening strategy compared to endoscopy in diagnosis of varices in liver cirrhosis
  • Publication Type:
    Working discussion paper
  • Authors:
    Pizzo E, Saygin Avsar T, Tsochatzis E
  • Publisher:
  • Publication date:
  • Status:
    In preparation
Background & Aims While upper GI endoscopy (EGD) remains the gold standard for detecting varices in cirrhosis, a combination of non-invasive transient elastography (TE) and platelet count (TE-P) could predict patients at risk needing an endoscopy. Despite the small risk of false negatives, TE-P could avoid inappropriate endoscopies, with a potential cost saving for the NHS. This study aimed to perform a cost-effectiveness analysis of TE-P compared to EGD in diagnosis of varices for patients with liver cirrhosis. Approach & Results We built an analytical decision model to estimate the cost and benefits of using TE-P compared to EGD in patients diagnosed with cirrhosis. The analysis was performed from the National Health Service (NHS) perspective, over one to 20 years. A Markov model was populated with data from published evidence and unit costs from the NHS reference costs. Outcomes were measured in terms of Quality Adjusted Life Years (QALYs) and avoided deaths. Cost-effectiveness of TE-P was presented in terms of Incremental Cost-Effectiveness Ratio (ICER) and Net Monetary Benefit (NMB). Liver elastography combined with platelet was a dominant option compared to endoscopy: over a cohort of 1000 patients TE-P saves £254,960 over 5 years and £1,546 over 20 years and 190 and 690 QALYs respectively. The Incremental Net Monetary Benefit of TE-P compared to EDG was estimated between £13,8 million and £20,7 million. Conclusions The findings demonstrate that a non-invasive elastography combined with platelet is not only cost-effective, but cost-saving in the long term, suggesting that this intervention should be implemented in the NHS on the basis of safety, appropriateness and economic grounds.
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