COST-EFFECTIVENESS ANALYSIS OF ULTRASONOGRAPHY SCREENING FOR NON-ALCOHOLIC FATTY LIVER DISEASE IN METABOLIC SYNDROME PATIENTS

Abstract

Background/Aimed: Non-alcoholic fatty liver disease (NAFLD) is an emerging problem worldwide including the Asia-Pacific region. It can be diagnosed by non-invasive and low-cost liver ultrasonography with high sensitivity and specificity. Metabolic syndrome is also a common and well known as a major risk factor for NAFLD. However, there are no current data on the cost-effectiveness analysis of early screening ultrasonography with lifestyle modification as an early intervention in this high risk group. This study aimed to perform the cost-effectiveness analysis of ultrasonography screening for NAFLD in metabolic syndrome patients in the context of Thailand. Materials and Methods: A cost- effectiveness analysis using a hybrid model consisting of a decision tree and Markov models was conducted over the patients’ lifetimes under societal perspective to compare costs and health benefits of ultrasonography screening for NAFLD with intervention by weight reduction in a cohort of metabolic syndrome patients aged 50 years versus no screening. The effectiveness and utility parameters were determined by systematic literature reviews, while costs and mortality parameters were determined using Thailand database analysis. All costs were presented in 2014 Thai Baht, THB. The discount rate of 3% was applied for both costs and outcomes. One-way and probabilistic sensitivity analyses were also performed. Results: The outcome measurement was the Incremental Cost-Effectiveness Ratio (ICER), with 160,000 THB or less per 1 Quality-Adjusted Life Year (QALY) gained considered as cost-effective. Ultrasonography screening with weight reduction was cost-effective with ICER of 19,706 THB/QALY gained when comparison with no screening. The annual probability of no advanced fibrosis progression to advanced fibrosis, the annual probability of advanced fibrosis progression to compensated cirrhosis, and risk reduction of weight reduction were the most three influential parameters on ICERs. According to willingness-to-pay of Thailand, the probability of ultrasonography screening being cost-effective was 67%. Conclusions: Ultrasonography screening for NAFLD with weight reduction in metabolic syndrome patients is a cost-effective screening in Thailand with low sensitive. Policy makers may consider our findings as part of information for their decision making.