Economic Evaluation of Transient Elastography for Significant Fibrosis Detection in Patients With Diabetes Mellitus in Thailand
Author(s)
Chayanis Kositamongkol, PharmD, MSc1, Alissa Ratanatawan, MD, PhD2, Pichaya Tantiyavarong, MD, PhD2, Prawej Mahawithitwong, MD3, Prawat Kositamongkol, MD3, Pochamana Phisalprapa, MD, PhD3;
1Faculty of Medicine Siriraj Hospital, Mahidol University and Faculty of Medicine, Thammasat University, Bangkok, Thailand, 2Faculty of Medicine, Thammasat University, Pathumthani, Thailand, 3Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
1Faculty of Medicine Siriraj Hospital, Mahidol University and Faculty of Medicine, Thammasat University, Bangkok, Thailand, 2Faculty of Medicine, Thammasat University, Pathumthani, Thailand, 3Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Presentation Documents
OBJECTIVES: The association between diabetes mellitus (DM) and non-alcoholic fatty liver disease (NAFLD) is well-documented, with DM heightens risk of developing NAFLD and liver fibrosis. This study aims to evaluate the cost-effectiveness and budget impact of transient elastography (TE) for detecting significant fibrosis in patients with DM in Thailand.
METHODS: A cost-utility analysis was conducted using a decision tree and Markov model over a lifetime horizon, adopting a societal perspective. The model included 11 health states related to NAFLD, comparing no screening against one-time screening strategies in patients aged 50 years as a base-case analysis. The strategies involve fibrosis-4 index then TE (FIB-4+TE), steatosis-associated fibrosis estimator score then TE (SAFE+TE), and TE alone. Key parameters included screening rates, sensitivity and specificity of tests, treatment effectiveness, mortality rates from cardiovascular diseases and hepatic-related events. Heath state-specific utilities were derived from previous publications. Costs were calculated using primary data from Siriraj Hospital and previous publications. The analysis applied a discount rate of 3% per year. Incremental cost-effectiveness ratios (ICERs) were calculated and compared against a willingness-to-pay threshold of 4619 USD/quality-adjusted life-year (QALY) gained (1 USD = 34.64 THB). A 5-year budget impact was estimated from a payer perspective.
RESULTS: Among the screening methods evaluated, TE alone yielded the highest total lifetime costs (5,770 USD) and QALYs (12.81 QALYs). Compared to no screening, all strategies demonstrated cost-effectiveness with ICERs of 1297, 1422, and 1980 THB/QALY gained for FIB-4+TE, SAFE+TE, and TE alone, respectively. TE alone emerged as the best-buy option when compared to the other strategies. Estimated annual budget impacts were substantial, amounting to 10.8 million, 21.8 million, and 21.0 million USD for FIB-4+TE, SAFE+TE, and TE alone, respectively.
CONCLUSIONS: Implementing screening for significant fibrosis in patients with DM is deemed cost-effective. However, considerations regarding the budget impact and accessibility of TE are critical for practical implementation.
METHODS: A cost-utility analysis was conducted using a decision tree and Markov model over a lifetime horizon, adopting a societal perspective. The model included 11 health states related to NAFLD, comparing no screening against one-time screening strategies in patients aged 50 years as a base-case analysis. The strategies involve fibrosis-4 index then TE (FIB-4+TE), steatosis-associated fibrosis estimator score then TE (SAFE+TE), and TE alone. Key parameters included screening rates, sensitivity and specificity of tests, treatment effectiveness, mortality rates from cardiovascular diseases and hepatic-related events. Heath state-specific utilities were derived from previous publications. Costs were calculated using primary data from Siriraj Hospital and previous publications. The analysis applied a discount rate of 3% per year. Incremental cost-effectiveness ratios (ICERs) were calculated and compared against a willingness-to-pay threshold of 4619 USD/quality-adjusted life-year (QALY) gained (1 USD = 34.64 THB). A 5-year budget impact was estimated from a payer perspective.
RESULTS: Among the screening methods evaluated, TE alone yielded the highest total lifetime costs (5,770 USD) and QALYs (12.81 QALYs). Compared to no screening, all strategies demonstrated cost-effectiveness with ICERs of 1297, 1422, and 1980 THB/QALY gained for FIB-4+TE, SAFE+TE, and TE alone, respectively. TE alone emerged as the best-buy option when compared to the other strategies. Estimated annual budget impacts were substantial, amounting to 10.8 million, 21.8 million, and 21.0 million USD for FIB-4+TE, SAFE+TE, and TE alone, respectively.
CONCLUSIONS: Implementing screening for significant fibrosis in patients with DM is deemed cost-effective. However, considerations regarding the budget impact and accessibility of TE are critical for practical implementation.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
EE334
Topic
Economic Evaluation
Topic Subcategory
Budget Impact Analysis
Disease
SDC: Cardiovascular Disorders (including MI, Stroke, Circulatory), SDC: Diabetes/Endocrine/Metabolic Disorders (including obesity), SDC: Gastrointestinal Disorders