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Screening for Nonalcoholic Steatohepatitis in Individuals with Type 2 Diabetes: A Cost-Effectiveness Analysis

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Abstract

Background and Aim

Individuals with type 2 diabetes are at heightened risk for nonalcoholic fatty liver disease, which gives rise to nonalcoholic steatohepatitis (NASH) and cirrhosis. Yet, current guidelines do not recommend screening for NASH among these high-risk patients. Using a simulation model, we assessed the effectiveness and cost-effectiveness of screening diabetic patients for NASH.

Methods

A Markov model was constructed to compare two management strategies for 50-year-olds with diabetes. In the No Screening strategy, patients do not undergo screening, although NASH may be diagnosed incidentally over their lifetime. In the NASH Screening strategy, all patients receive a one-time screening ultrasound. Individuals with fatty infiltration on ultrasound then have a liver biopsy, and those found to have NASH receive medical therapy, which decreases progression to cirrhosis. Endpoints evaluated included quality-adjusted life years (QALYs) gained, costs, and incremental cost-effectiveness ratios (ICERs).

Results

Screening for NASH decreased the number of individuals who developed cirrhosis by 12.9 % and resulted in an 11.9 % decrease in liver-related deaths. However, screening resulted in 0.02 fewer QALYs, due to the disutility associated with treatment, and was therefore dominated by the No Screening strategy. When the model excluded this quality-of-life decrement, screening became cost-effective, at an ICER of $42,134 per QALY.

Conclusions

Screening for NASH may improve liver-related outcomes, but is not cost-effective at present, due to side effects of therapy. As better tolerated treatments for NASH become available, even with modest efficacy, screening for NASH will become cost-effective.

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Acknowledgments

Kathleen E. Corey and Raymond T. Chung received grant support from NIH K23 DK099422 and K24 DK078772, respectively.

Author contribution

Kathleen E. Corey, Matthew J. Klebanoff and Chin Hur were involved in study concept and design, and acquisition of data; Kathleen E. Corey, Matthew J. Klebanoff, Raymond T. Chung, Chin Hur were involved in analysis and interpretation of data; Kathleen E. Corey, Matthew J. Klebanoff, Chin Hur drafted the manuscript; Kathleen E. Corey, Matthew J. Klebanoff, Raymond T. Chung, Chin Hur were involved in critical revision of the manuscript for important intellectual content; Kathleen E. Corey, Matthew J. Klebanoff, Angela C. Tramontano were involved in administration; Kathleen E. Corey, Matthew J. Klebanoff, Angela C. Tramontano provided technical or material support; and Kathleen E. Corey, Chin Hur were involved in study supervision.

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Authors and Affiliations

  1. Gastrointestinal Unit, Massachusetts General Hospital, Boston, MA, USA

    Kathleen E. Corey, Matthew J. Klebanoff, Raymond T. Chung & Chin Hur

  2. Harvard Medical School, Boston, MA, USA

    Kathleen E. Corey, Raymond T. Chung & Chin Hur

  3. Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA, USA

    Matthew J. Klebanoff, Angela C. Tramontano & Chin Hur

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  1. Kathleen E. Corey
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Correspondence to Kathleen E. Corey.

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Conflict of interest

Dr. Chung received funding from Gilead Sciences (not for NAFLD research). The other authors declare that they have no conflict of interest.

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Corey, K.E., Klebanoff, M.J., Tramontano, A.C. et al. Screening for Nonalcoholic Steatohepatitis in Individuals with Type 2 Diabetes: A Cost-Effectiveness Analysis. Dig Dis Sci 61, 2108–2117 (2016). https://doi.org/10.1007/s10620-016-4044-2

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