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Clinical- and Cost-Effectiveness of Liver Disease Staging in Hepatitis C Virus Infection: A Microsimulation Study

  • 0Department of Medicine, Section of Infectious Diseases, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA.
Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America +

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November 13, 2024

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November 13, 2024

View abstract on PubMed

Summary

This summary is machine-generated.

For chronic hepatitis C virus (HCV) infection, Fibrosis-4 index (FIB-4) staging alone offers the best clinical outcomes and cost-effectiveness. Treatment should not be delayed for transient elastography (TE) staging.

Area Of Science

  • Hepatology
  • Medical Economics
  • Public Health

Background

  • Chronic hepatitis C virus (HCV) infection management requires accurate liver disease assessment.
  • Current guidelines for pre-treatment fibrosis staging in HCV vary, presenting challenges in balancing test availability and accuracy.
  • This study evaluates the clinical outcomes and cost-effectiveness of different fibrosis staging strategies for HCV.

Purpose Of The Study

  • To compare the clinical outcomes and cost-effectiveness of various fibrosis staging strategies for chronic hepatitis C virus (HCV) infection.
  • To determine the optimal testing modality for HCV fibrosis assessment in a US healthcare setting.
  • To inform clinical guidelines regarding pre-treatment evaluation for HCV.

Main Methods

  • A lifetime microsimulation model was used to compare five strategies for adults with chronic HCV in US health centers.
  • Strategies included no staging, Fibrosis-4 index (FIB-4) alone, transient elastography (TE) alone, a staged approach (FIB-4 followed by TE for intermediate scores), and both tests for all patients.
  • Outcomes assessed included infection cure rates, cirrhosis development, liver-related deaths, costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs), using a Medicaid perspective and 2021 costs.

Main Results

  • The Fibrosis-4 index (FIB-4) alone strategy yielded the best clinical outcomes: 87.7% cure rate, 8.7% cirrhosis, and 4.6% liver-related deaths.
  • Transient elastography (TE) strategies resulted in lower cure rates (58.5%-76.6%) and higher rates of cirrhosis (16.8%-29.4%) and liver-related deaths (11.6%-22.6%).
  • FIB-4 alone was cost-effective with an ICER of $12,869 per QALY gained compared to no staging; TE strategies were less cost-effective, particularly with loss to follow-up (LTFU).

Conclusions

  • Fibrosis-4 index (FIB-4) staging alone provides optimal clinical outcomes and is a cost-effective approach for chronic hepatitis C virus (HCV) infection.
  • Transient elastography (TE) strategies are associated with worse clinical outcomes and higher costs compared to FIB-4 alone.
  • Initiating treatment for chronic HCV should not be postponed awaiting fibrosis staging via TE, especially in scenarios with potential LTFU or point-of-care testing.

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