@article{TEXTUAL,
      recid = {7458},
      author = {Tapper, Elliot B. and Hunink, M. G. Myriam and Afdhal,  Nezam H. and Lai, Michelle and Sengupta, Neil},
      title = {Cost-Effectiveness Analysis: Risk Stratification of  Nonalcoholic Fatty Liver Disease (NAFLD) by the Primary  Care Physician Using the NAFLD Fibrosis Score},
      journal = {PLOS ONE},
      address = {2016-02-23},
      number = {TEXTUAL},
      abstract = {&lt;p&gt;Background: The complications of Nonalcoholic Fatty  Liver Disease (NAFLD) are dependent on the presence of  advanced fibrosis. Given the high prevalence of NAFLD in  the US, the optimal evaluation of NAFLD likely involves  triage by a primary care physician (PCP) with advanced  disease managed by gastroenterologists.&lt;/p&gt; &lt;p&gt;Methods: We  compared the cost-effectiveness of fibrosis risk-assessment  strategies in a cohort of 10,000 simulated American  patients with NAFLD performed in either PCP or referral  clinics using a decision analytical microsimulation  state-transition model. The strategies included use of  vibration-controlled transient elastography (VCTE), the  NAFLD fibrosis score (NFS), combination testing with NFS  and VCTE, and liver biopsy (usual care by a specialist  only). NFS and VCTE performance was obtained from a  prospective cohort of 164 patients with NAFLD. Outcomes  included cost per quality adjusted life year (QALY) and  correct classification of fibrosis.&lt;/p&gt; &lt;p&gt;Results:  Risk-stratification by the PCP using the NFS alone costs  5,985 USD per QALY while usual care costs 7,229 USD/QALY.  In the microsimulation, at a willingness-to-pay threshold  of $100,000, the NFS alone in PCP clinic was the most  cost-effective strategy in 94.2% of samples, followed by  combination NFS/VCTE in the PCP clinic (5.6%) and usual  care in 0.2%. The NFS based strategies yield the best  biopsy-correct classification ratios (3.5) while the  NFS/VCTE and usual care strategies yield more  correct-classifications of advanced fibrosis at the cost of  3 and 37 additional biopsies per classification.&lt;/p&gt;  &lt;p&gt;Conclusion: Risk-stratification of patients with NAFLD  primary care clinic is a cost-effective strategy that  should be formally explored in clinical practice.&lt;/p&gt;},
      url = {http://knowledge.uchicago.edu/record/7458},
}