Recognizing a need to bolster the growing evidence base of cost-effectiveness data relating to the use of NITs for detecting and monitoring NAFLD and NASH, NASHNET published a novel cost-effectiveness analysis (CEA) study in Gastroenterology, titled: “Screening for Non-Alcoholic Fatty Liver Disease in Persons with Type 2 Diabetes in the U.S. is Cost Effective: A Comprehensive Cost-Utility Analysis.”
Under the leadership of Dr. Mazen Noureddin, Director of the Liver Program at Cedars Sinai Medical Center, NASHNET advisors developed a Markov model to compare strategies of screening and treatment versus no-screening and treatment of NASH in hypothetical patients with NAFLD and Type 2 Diabetes (T2D). The advisors modeled six screening strategies in a hypothetical cohort of 55-year-old persons followed across 1-year cycles until their deaths.
Assuming a cost effectiveness threshold of $50,000/QALY, findings indicated that screening approaches 3 and 6 were cost effective, compared to the no-screening strategies, with ICERs of $35,274/QALY and $36,740/QALY respectively. Patients suspected to have NAFLD or NASH (NASH ≥ 2) were prescribed one year of intensive lifestyle intervention (ILI).
As the prevalence of NAFLD and NASH continues to rise, leveraging non-invasive tests (NITs) will become increasingly important to identify patients at greatest risk of adverse health outcomes or those who may benefit from early intervention. Dr. Noureddin remarked, “as the burden of NAFLD continues to grow, it is increasingly a financial and population health issue. It is imperative that we define appropriate screening strategies for identifying patients with NAFLD to improve overall health, diagnose the disease early, reduce the associated financial burden, and help inform the development of future professional guidelines.”
Dr. Mary Rinella, a Hepatologist at Northwestern Medicine commented, “these data provide additional rationale to screen for NASH in a high risk population such as diabetes. NASH is soon to be the primary indication for liver transplantation, and it already is in women, so developing an economical approach for healthcare organizations to identify patients with the disease will become vital as therapeutics come to market.” While liver biopsy remains the gold standard for diagnosing NASH, a number of NITs have emerged in recent years including the ultrasound, AST, ALT, VCTE, controlled attenuation parameter (CAP), and FIB-4.
This publication supports a growing body of evidence suggesting that screening for NAFLD/NASH in high risk populations could be cost effective. Researchers urge professional societies to take into consideration this growing evidence base when updating future guidelines.
Access the full CEA study in Gastroenterology via the link: https://www.gastrojournal.org/article/S0016-5085(20)35014-9/fulltext.