Non-alcoholic fatty liver disease screening in type 2 diabetes mellitus: A cost-effectiveness and price threshold analysis.
10.47102/annals-acadmedsg.2022284
- Author:
Bryan Peide CHOO
1
;
George Boon Bee GOH
;
Sing Yi CHIA
;
Hong Choon OH
;
Ngiap Chuan TAN
;
Jessica Yi Lyn TAN
;
Tiing Leong ANG
;
Yong Mong BEE
;
Yu Jun WONG
Author Information
1. Health Services Research, Changi General Hospital, Singapore.
- Publication Type:Journal Article
- MeSH:
Humans;
Non-alcoholic Fatty Liver Disease/diagnosis*;
Cost-Benefit Analysis;
Diabetes Mellitus, Type 2/diagnosis*;
Research;
Fibrosis
- From:Annals of the Academy of Medicine, Singapore
2022;51(11):686-694
- CountrySingapore
- Language:English
-
Abstract:
INTRODUCTION:The cost-effectiveness of screening asymptomatic non-alcoholic fatty liver disease (NAFLD) patients remains debatable, with current studies assuming lifelong benefits of NAFLD screening while neglecting cardiovascular outcomes. This study aims to assess the cost-effectiveness of NAFLD screening among type 2 diabetes mellitus (T2DM) patients, and to establish a price threshold for NAFLD treatment, when it becomes available.
METHOD:A Markov model was constructed comparing 4 screening strategies (versus no screening) to identify NAFLD with advanced fibrosis among T2DM patients: fibrosis-4 (FIB-4), vibration-controlled transient elastography (VCTE), FIB-4 and VCTE (simultaneous), and FIB-4 and VCTE (sequential). Sensitivity analyses and price threshold analyses were performed to assess parameter uncertainties in the results.
RESULTS:VCTE was the most cost-effective NAFLD screening strategy (USD24,727/quality-adjusted life year [QALY]), followed by FIB-4 (USD36,800/QALY), when compared to no screening. Probabilistic sensitivity analysis revealed a higher degree of certainty for VCTE as a cost-effective strategy compared to FIB-4 (90.7% versus 73.2%). The duration of expected screening benefit is the most influential variable based on incremental cost-effectiveness ratio tornado analysis. The minimum duration of screening benefit for NAFLD screening to be cost-effective was at least 2.6 years. The annual cost of NAFLD treatment should be less than USD751 for NAFLD screening to be cost-effective.
CONCLUSION:Both VCTE and FIB-4 are cost-effective NAFLD screening strategies among T2DM patients in Singapore. However, given the lack of access to VCTE at primacy care and potential budget constraints, FIB-4 can also be considered for NAFLD screening among T2DM patients in Singapore.
