Table 5 Budget impact analysis of introducing FIB-4, ELF and fibroscan into primary care risk stratification pathways compared to standard care after 1 year for a population of 60 million patients
Scenario 2 - FIB-4/ELF | Scenario 3 - FIB-4/ TE | Scenario 4 - SC + ELF | Scenario 5 - SC + TE | |
|---|---|---|---|---|
Pathway performance: | ||||
Incremental number of referrals (stratified as ≥F3 fibrosis) (% increase vs SOC) | − 587,700 (−70%) | − 533,217 (−67%) | − 474,000 (−56%) | − 242,340 (−25%) |
Incremental number of ≥F3 disease referred | 71,640 (53%) | 74,041 (45%) | 81,000 (39%) | 86,220 (25%) |
Incremental number of ≤F2 disease referred | − 659,340 (−85%) | − 607,258 (−78%) | − 555,021 (−71%) | − 328,560 (−42%) |
Incremental number of cirrhotics referred | 2786 (113%) | 2880 (116%) | 3153 (128%) | 3359 (136%) |
Incremental number of patients incorrectly identified as ≤F2 | −71,640 (−61%) | −74,041 (− 63%) | −81,000 (− 69%) | −86,220 (− 74%) |
IMPACT ON END STAGE LIVER DISEASE | ||||
BCLC Stage 0/A curable HCC (% of all HCC) | 121 (36%) | 125 (38%) | 137 (41%) | 146 (44%) |
BCLC Stage B-D incurable HCC (% of all HCC) | −121 (− 29%) | − 125 (− 30%) | −137 (− 33%) | − 146 (− 35%) |
Varices detected via surveillance programme (% of all new varices) | 50 (113%) | 51 (117%) | 57 (128%) | 60 (136%) |
Emergency presentation of varices (% of all new varices) | −50 (− 30%) | −51 (− 31%) | −57 (− 34%) | −60 (− 36%) |
Mild/Moderate ‘other’ complications | 5 (6%) | 5 (6%) | 6 (7%) | < 6 (7%) |
Severe ‘other’ complication requiring hospital admission | −5 (− 9%) | − 5 (− 9%) | − 6 (− 10%) | −6 (− 10%) |
Outcomes | ||||
Mortality / 1000 NAFLD patients | −67 (− 0.34%) | −69 (− 0.35%) | −76 (− 0.39%) | −81 (− 0.41%) |
Budget | ||||
Cost of tests | £24.9 M | £25.5 | £100.8 | £103.2 M |
Total expenditure | -£406 M (−23%) | -£364 M (−21%) | -£243 M (−14%) | -£65 M (− 4%) |