Table 4.
Base case analysis of introducing FIB-4, ELF and fibroscan into primary care risk stratification pathways compared to standard of care (scenario 1) after 1 year for 1000 patients with NAFLD
| Scenario 2 - FIB-4/ELF | Scenario 3 - FIB-4/ TE | Scenario 4 - SOC + ELF | Scenario 5 - SOC + TE | |
|---|---|---|---|---|
| Pathway performance: patients referred to specialist (secondary care) | ||||
|
Incremental number of referrals (stratified as ≥F3 fibrosis) (% increase vs SOC) |
−245 (− 70%) | − 222 (− 67%) | −198 (− 56%) | − 101 (25%) |
| Incremental number of ≥F3 disease referred | 30 (53%) | 31 (45%) | 34 (39%) | 36 (25%) |
| Incremental number of ≤F2 disease referred | −275 (−85%) | −253 (−78%) | − 231 (−71%) | −137 (−42%) |
| Incremental number of cirrhotics referred | 1.16 (113%) | 1.20 (116%) | 1.31 (128%) | 1.40 (136%) |
| Pathway performance: patients remain under primary care management | ||||
| Incremental number of patient stratified as ≤F2 fibrosis (Primary care management) | 245 (38%) | 222 (34%) | 198 (30%) | 101 (15%) |
| Incremental number of patients correctly identified as ≤F2 | 274 (46%) | 253 (42%) | 231 (38%) | 137 (23%) |
| Incremental number of patients incorrectly identified as ≤F2 | −30 (−61%) | −31 (−63%) | −34 (− 69%) | −36 (−74%) |
| Overall performance of pathways | ||||
| Sensitivity | 0.75 | 0.76 | 0.80 | 0.83 |
| Specificity | 0.95 | 0.92 | 0.90 | 0.80 |
| Positive Predictive Value | 0.53 | 0.45 | 0.39 | 0.25 |
| Negative Predictive Value | 0.98 | 0.98 | 0.98 | 0.98 |
| Positive Likelihood Ratio | 14.11 | 9.96 | 8.00 | 4.10 |
| Negative Likelihood ratio | 0.27 | 0.26 | 0.22 | 0.21 |
| Impact on end stage liver disease | ||||
|
BCLC Stage 0/A curable HCC (% of all HCC) |
0.06 (36%) | 0.06 (38%) | 0.07 (41%) | 0.08 (44%) |
| BCLC Stage B-D incurable HCC (% of all HCC) | −0.06 (−29%) | −0.07 (−30%) | −0.07 (−33%) | −0.08 (−35%) |
| Varices detected via surveillance programme (% of all new varices) | 0.02 (113%) | 0.02 (117%) | 0.02 (128%) | 0.03 (136%) |
|
Emergency presentation of varices (% of all new varices) |
−0.02 (−30%) | − 0.02 (−31%) | −0.02 (−34%) | −0.03 (−36%) |
| Mild/Moderate ‘other’ complications | < 0.01 (6%) | < 0.01 (6%) | < 0.01 (7%) | < 0.01 (7%) |
| Severe ‘other’ complication | < 0.01 (−9%) | < 0.01 (−9%) | < 0.01 (−10%) | < 0.01 (−10%) |
| Number of liver transplants (of all cirrhotics known to specialist) | 0.02 (32%) | 0.02 (33%) | 0.03 (36%) | 0.03 (39%) |
| Outcomes | ||||
| Mortality / 1000 NAFLD patients | −0.03 (−0.34%) | − 0.03 (− 0.35%) | −0.04 (− 0.39%) | −0.04 (− 0.41%) |
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