Cost-utility analysis of nonalcoholic steatohepatitis screening

Nonalcoholic fatty liver disease (NAFLD) is the most common liver disease in Western countries. No studies have examined the cost-effectiveness of screening its advanced form, nonalcoholic steatohepatitis (NASH). We performed a cost-utility analysis of annual noninvasive screening strategies using third-party payer perspective in a general population in comparison to screening a high-risk obese or diabetic population. Screening algorithms involved well-studied techniques, including NAFLD fibrosis score, transient elastography (TE), and acoustic radiation force impulse (ARFI) imaging for detecting advanced fibrosis (a parts per thousand yen F3); and plasma cytokeratin (CK)-18 for NASH detection. Liver biopsy and magnetic resonance elastography (MRE) were compared as confirmation methods. Canadian dollar (CAD or C$) costs were adjusted for inflation and discounted at 5 %. Incremental cost-effectiveness ratio (ICER) of a parts per thousand currency signC$ 50,000 was considered cost-effective. Compared with no screening, screening with NAFLD fibrosis score/TE/CK-18 algorithm with MRE as confirmation for advanced fibrosis had an ICER of C$ 26,143 per quality-adjusted life year (QALY) gained. Screening in high-risk obese or diabetic populations was more cost-effective, with an ICER of C$ 9,051 and C$ 7,991 per quality-adjusted life-year (QALY) gained, respectively. Liver biopsy confirmation was not found to be cost-effective. Our model suggests that annual NASH screening in high-risk obese or diabetic populations can be cost-effective. aEuro cent This cost-utility analysis suggests that screening for nonalcoholic steatohepatitis may be cost-effective. aEuro cent In particular, screening of high-risk obese or diabetic populations is more cost-effective. aEuro cent Magnetic resonance elastography was more cost-effective to confirm disease compared to biopsy. aEuro cent More studies are needed to determine quality of life in nonalcoholic steatohepatitis. aEuro cent More management strategies for nonalcoholic steatohepatitis are also needed.