Cost‐effectiveness of noninvasive liver fibrosis tests for treatment decisions in patients with chronic hepatitis B in the UK: systematic review and economic evaluation

We compared the cost‐effectiveness of various noninvasive tests (NITs) in patients with chronic hepatitis B and elevated transaminases and/or viral load who would normally undergo liver biopsy to inform treatment decisions. We searched various databases until April 2012. We conducted a systematic review and meta‐analysis to calculate the diagnostic accuracy of various NITs using a bivariate random‐effects model. We constructed a probabilistic decision analytical model to estimate health care costs and outcomes quality‐adjusted‐life‐years (QALYs) using data from the meta‐analysis, literature, and national UK data. We compared the cost‐effectiveness of four decision‐making strategies: testing with NITs and treating patients with fibrosis stage ≥F2, testing with liver biopsy and treating patients with ≥F2, treat none (watchful waiting) and treat all irrespective of fibrosis. Treating all patients without prior fibrosis assessment had an incremental cost‐effectiveness ratio (ICER) of £28 137 per additional QALY gained for HBeAg‐negative patients. For HBeAg‐positive patients, using Fibroscan was the most cost‐effective option with an ICER of £23 345. The base case results remained robust in the majority of sensitivity analyses, but were sensitive to changes in the ≥F2 prevalence and the benefit of treatment in patients with F0–F1. For HBeAg‐negative patients, strategies excluding NITs were the most cost‐effective: treating all patients regardless of fibrosis level if the high cost‐effectiveness threshold of £30 000 is accepted; watchful waiting if not. For HBeAg‐positive patients, using Fibroscan to identify and treat those with ≥F2 was the most cost‐effective option.