Skip to main content

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

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 - 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%)
  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 for a population of 60 million patients with 20% NAFLD prevelance risk stratified on a 5 year cycle