PMID- 36453216
OWN - NLM
STAT- MEDLINE
DCOM- 20221202
LR  - 20221202
IS  - 2972-4066 (Electronic)
IS  - 0304-4602 (Linking)
VI  - 51
IP  - 11
DP  - 2022 Nov
TI  - Non-alcoholic fatty liver disease screening in type 2 diabetes mellitus: A 
      cost-effectiveness and price threshold analysis.
PG  - 686-694
LID - 10.47102/annals-acadmedsg.2022284 [doi]
AB  - 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.
FAU - Choo, Bryan Peide
AU  - Choo BP
AD  - Health Services Research, Changi General Hospital, Singapore.
FAU - Goh, George Boon Bee
AU  - Goh GBB
FAU - Chia, Sing Yi
AU  - Chia SY
FAU - Oh, Hong Choon
AU  - Oh HC
FAU - Tan, Ngiap Chuan
AU  - Tan NC
FAU - Tan, Jessica Yi Lyn
AU  - Tan JYL
FAU - Ang, Tiing Leong
AU  - Ang TL
FAU - Bee, Yong Mong
AU  - Bee YM
FAU - Wong, Yu Jun
AU  - Wong YJ
LA  - eng
PT  - Journal Article
PL  - Singapore
TA  - Ann Acad Med Singap
JT  - Annals of the Academy of Medicine, Singapore
JID - 7503289
SB  - IM
MH  - Humans
MH  - *Non-alcoholic Fatty Liver Disease/complications/diagnosis
MH  - Cost-Benefit Analysis
MH  - *Diabetes Mellitus, Type 2/complications/diagnosis
MH  - Research
MH  - Fibrosis
EDAT- 2022/12/02 06:00
MHDA- 2022/12/03 06:00
CRDT- 2022/12/01 04:43
PHST- 2022/12/01 04:43 [entrez]
PHST- 2022/12/02 06:00 [pubmed]
PHST- 2022/12/03 06:00 [medline]
AID - 10.47102/annals-acadmedsg.2022284 [doi]
PST - ppublish
SO  - Ann Acad Med Singap. 2022 Nov;51(11):686-694. doi: 
      10.47102/annals-acadmedsg.2022284.