Transient elastography for screening of liver fibrosis: cost-effectiveness analysis from six prospective cohorts in Europe and Asia.

Nonalcoholic fatty liver disease (NAFLD) and alcoholic liver disease (ALD) pose an important challenge to current clinical healthcare pathways due to a large number of at-risk patients. Therefore, we aimed to explore the cost-effectiveness of transient elastography (TE) as a screening method to detect liver fibrosis in a primary care pathway.Cost-effectiveness analysis using real-life individual patient data from six independent prospective cohorts (five from Europe and one from Asia). A diagnostic algorithm with conditional inference trees was developed to explore the relationships between liver stiffness, socio-demographics, comorbidities, and hepatic fibrosis, the latter assessed by fibrosis scores (FIB-4, NFS) and liver biopsy in a subset of 352 patients. We compared the incremental cost-effectiveness of a screening strategy against standard of care alongside the numbers needed to screen to diagnose a patient with fibrosis stage ≥F2.The data set encompassed 6,295 participants (mean age 55±12 years, BMI 27±5 kg/m, liver stiffness 5.6±5.0 kPa). A 9.1 kPa TE cut-off provided the best accuracy for the diagnosis of significant fibrosis (≥F2) in general population settings, whereas a threshold of 9.5 kPa was optimal for populations at-risk for alcoholic liver disease. TE with the proposed cut-offs outperformed fibrosis scores in terms of accuracy. Screening with TE was cost-effective with mean incremental cost-effectiveness ratios ranging from 2,570 €/QALY (95% CI 2,456-2,683) for a population at-risk for alcoholic liver disease (age ≥45 years) to 6,217 €/QALY (95% CI 5,832-6,601) in the general population. Overall, there was a 12% chance of TE screening being cost-saving across countries and populations.Screening for liver fibrosis with transient elastography in primary care is a cost-effective intervention for European and Asian populations and may even be cost-saving.The lack of optimized public health screening strategies for the detection of liver fibrosis in adults without known liver disease presents a major healthcare challenge. Analyses from six independent international cohorts with transient elastography measurements based on economic modelling shows that a community-based risk-stratification strategy for alcoholic and non-alcoholic fatty liver diseases is cost-effective through earlier identification of patients and potentially cost-saving for our healthcare systems.