Imperial College London
Alternate

ProfessorMarkThursz

Faculty of Medicine, Department of Metabolism, Digestion and Reproduction

Professor of Hepatology. Head of Department
 
 
 
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Contact

 

+44 (0)20 3312 1903m.thursz

 
 
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Assistant

 

Ms Dawn Campbell +44 (0)20 3312 6454

 
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Location

 

Norfolk PlaceSt Mary's Campus

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Summary

 

Publications

Citation

BibTex format

@article{Forlano:2022:rs.3.rs-2135338/v1,
author = {Forlano, R and Stanic, T and Jayawardana, S and Mullish, B and Yee, M and Mossialos, E and Goldin, R and Petta, S and Tsochatzis, E and Thursz, M and Manousou, P},
doi = {rs.3.rs-2135338/v1},
title = {Clinical and cost-effectiveness analysis of community-based screening strategies for non-alcoholic fatty liver disease in patients with type-2 diabetes mellitus},
url = {http://dx.doi.org/10.21203/rs.3.rs-2135338/v1},
year = {2022}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - <jats:title>Abstract</jats:title>        <jats:p>Background & Aims: We investigated the prevalence of non-alcoholic fatty liver disease(NAFLD) in patients with type 2 diabetes mellitus(T2DM) in primary care and developed a risk-stratification pathway. We also assessed the cost-utility of different screening strategies for NAFLD in the diabetic community.Methods Consecutive T2DM patients underwent screening for liver diseases, including liver stiffness measurement(LSM). Binary logistic was used to predict factors associated with significant fibrosis. We used independent predictors of significant and advanced fibrosis to generate a predictive score for this population (BIMAST),and validated it internally and externally. Five screening strategies were compared against standard of care (SOC): BIMAST score, ultrasound plus abnormal liver function tests, FIB-4, NAFLD fibrosis score, and fibroscan. A Markov model was built upon four health states based on fibrosis status. We generated the cost per quality-adjusted life year(QALY) gained and calculated the incremental cost-effectiveness ratio (ICER) in the base-case analysis conducted over a lifetime horizon.Results Among 300 patients enrolled (287 included), 64% (186) had NAFLD and 10% (28) other causes of liver disease. Patients with significant fibrosis, advanced fibrosis, and cirrhosis due to NAFLD accounted for 17% (50/287), 11% (31/287), and 3% (8/287), respectively.  BIMAST score validation showed an excellent diagnostic performance in primary care improving false negatives from 38–10% compared to FIB-4. In the cost-utility analysis, ICER was £2,337.92/QALY for BIMAST and £2,480/QALY for fibroscan. When transition probabilities, utilities, screening effect, and cost inputs were modified, we found a > 99% probability of NAFLD screening tests being cost-effective compared to SOC in all evaluated scenarios.Conclusion Screening for NAFLD in diabetic patient
AU  - Forlano,R
AU  - Stanic,T
AU  - Jayawardana,S
AU  - Mullish,B
AU  - Yee,M
AU  - Mossialos,E
AU  - Goldin,R
AU  - Petta,S
AU  - Tsochatzis,E
AU  - Thursz,M
AU  - Manousou,P
DO  - rs.3.rs-2135338/v1
PY  - 2022///
TI  - Clinical and cost-effectiveness analysis of community-based screening strategies for non-alcoholic fatty liver disease in patients with type-2 diabetes mellitus
UR  - http://dx.doi.org/10.21203/rs.3.rs-2135338/v1
ER  -
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