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Table 4 Base case analysis of introducing FIB-4, ELF and fibroscan into primary care risk stratification pathways compared to standard of care (scenario 1) after 1 year for 1000 patients with NAFLD

From: Cost-comparison analysis of FIB-4, ELF and fibroscan in community pathways for non-alcoholic fatty liver disease

  Scenario 2 - FIB-4/ELF Scenario 3 - FIB-4/ TE Scenario 4 - SOC + ELF Scenario 5 - SOC + TE
Pathway performance: patients referred to specialist (secondary care)
 Incremental number of referrals (stratified as ≥F3 fibrosis)
(% increase vs SOC)
−245 (− 70%) − 222 (− 67%) −198 (− 56%) − 101 (25%)
 Incremental number of ≥F3 disease referred 30 (53%) 31 (45%) 34 (39%) 36 (25%)
 Incremental number of ≤F2 disease referred −275 (−85%) −253 (−78%) − 231 (−71%) −137 (−42%)
 Incremental number of cirrhotics referred 1.16 (113%) 1.20 (116%) 1.31 (128%) 1.40 (136%)
Pathway performance: patients remain under primary care management
 Incremental number of patient stratified as ≤F2 fibrosis (Primary care management) 245 (38%) 222 (34%) 198 (30%) 101 (15%)
 Incremental number of patients correctly identified as ≤F2 274 (46%) 253 (42%) 231 (38%) 137 (23%)
 Incremental number of patients incorrectly identified as ≤F2 −30 (−61%) −31 (−63%) −34 (− 69%) −36 (−74%)
Overall performance of pathways
 Sensitivity 0.75 0.76 0.80 0.83
 Specificity 0.95 0.92 0.90 0.80
 Positive Predictive Value 0.53 0.45 0.39 0.25
 Negative Predictive Value 0.98 0.98 0.98 0.98
 Positive Likelihood Ratio 14.11 9.96 8.00 4.10
 Negative Likelihood ratio 0.27 0.26 0.22 0.21
Impact on end stage liver disease
 BCLC Stage 0/A curable HCC
(% of all HCC)
0.06 (36%) 0.06 (38%) 0.07 (41%) 0.08 (44%)
 BCLC Stage B-D incurable HCC (% of all HCC) −0.06 (−29%) −0.07 (−30%) −0.07 (−33%) −0.08 (−35%)
 Varices detected via surveillance programme (% of all new varices) 0.02 (113%) 0.02 (117%) 0.02 (128%) 0.03 (136%)
 Emergency presentation of varices
(% of all new varices)
−0.02 (−30%) − 0.02 (−31%) −0.02 (−34%) −0.03 (−36%)
 Mild/Moderate ‘other’ complications < 0.01 (6%) < 0.01 (6%) < 0.01 (7%) < 0.01 (7%)
 Severe ‘other’ complication < 0.01 (−9%) < 0.01 (−9%) < 0.01 (−10%) < 0.01 (−10%)
 Number of liver transplants (of all cirrhotics known to specialist) 0.02 (32%) 0.02 (33%) 0.03 (36%) 0.03 (39%)
Outcomes
 Mortality / 1000 NAFLD patients −0.03 (−0.34%) − 0.03 (− 0.35%) −0.04 (− 0.39%) −0.04 (− 0.41%)
  1. Tabulated analysis of the impact of non-invasive liver fibrosis tests for the management of patients with NAFLD (scenarios 2–5) compared to the standard of care (scenario 1) in the primary care setting