Cost Effectiveness of Fibroscan in Assessing Patients with Hepatitis C
McCarthy K, Corbett S, Ramlaul N, Healy E, Crosbie
Department of Hepatology, Cork University Hospital, Cork
Chronic hepatitis C (HCV) is a significant cause of morbidity and mortality affecting almost 200 million people worldwide. HCV is a risk factor for cirrhosis and hepatocellular carcinoma (HCC). Patients require regular screening to assess progression of the disease. Liver biopsy has to date been the gold standard procedure. However, it is invasive, is associated with complications in some cases and is expensive, with costs including bed, radiology and pathology fees. Ultrasound-based transient elastography (Fibroscan) is a non-invasive, inexpensive test with no associated side effects, which it is hoped will replace the need for liver biopsy in assessing the degree of hepatic fibrosis.
This study aims to assess the cost effectiveness of regular surveillance with Fibroscan for progression of hepatic fibrosis in chronic HCV patients when compared with percutaneous liver biopsy.
Chronic HCV patients who underwent Fibroscan in the 12 months, April 2014 to April 2015 at Cork University Hospital were enrolled in this study. The cost of each Fibroscan procedure, in addition to the initial purchase of the Fibroscan machine, depreciation of same and the annual maintenance fee, provided an overall annual costing. The cost of the total number of biopsies carried out in the same time period provided a comparison. These two figures were then analysed to assess the cost effectiveness of Fibroscan.
234 chronic HCV patients underwent Fibroscan during the study time period. Year one expenditure, including the purchase of the machine and its operating expenses, amounted to €82,771. In the absence of a Fibroscan machine and to obtain comparable assessment of hepatic fibrosis, all patients would have had to undergo a liver biopsy. Total cost of this procedure would have amounted to €81,009, which is in essence cost neutral. However the real saving should be evident in year two and subsequent years, where, based on the same numbers, the Fibroscan annual operating cost (including depreciation of the machine) reduces to €14,371. Previous guidelines would have recommended a liver biopsy every 5 years in many patients with hepatitis C resulting in a cost of €81,009. Cost effectiveness of Fibroscan allows more frequent assessment to be performed. There are also ‘hidden’ costs savings, e.g. reduced absence from work, travel costs and time saving/convenience of Fibroscan.
Regular surveillance with Fibroscan is a cost effective and convenient strategy to assess the degree of hepatic fibrosis in chronic HCV patients, replacing the need for both expensive and invasive liver biopsies.