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Diagnosis and Monitoring of Liver Fibrosis in Patients with Chronic Hepatitis C: A Review of the Clinical Evidence and Cost Effectiveness

Published on: March 8, 2012
Project Number: RC0327-000
Product Line: Rapid Response
Research Type: Devices and Systems
Report Type: Summary with Critical Appraisal
Result type: Report

Question

  1. What is the comparative accuracy and validity of non-invasive methods versus liver biopsy for detecting and grading liver fibrosis in patients with chronic hepatitis C viral infection?
  2. What is the cost effectiveness of non-invasive methods versus liver biopsy for detecting and grading liver fibrosis in patients with chronic hepatitis C viral infection?

Key Message

Various non-invasive methods including transient elastography, Fibrotest, and aminotransferase-to-platelet ratio index have been studied for the detection and grading of hepatic fibrosis in patients with chronic hepatitis C viral infection. Diagnostic accuracy (sensitivity, specificity, positive predictive value and negative predictive value) for all tests compared with liver biopsy varied across studies. Moderate to high area under receiver-operator curve (AUROC) values (range: approximately 0.7 to 1.0) were reported for the three tests (FT, TE, and APRI) that had the largest body of evidence to validate them. Accuracy was generally higher for cirrhosis compared with earlier stages of fibrosis. Despite its limitations, liver biopsy remains the gold standard in terms of accuracy of diagnosis. There is limited evidence on the cost-effectiveness of non-invasive methods, and further studies are required.

Tags

hepatitis, liver fibrosis, chronic hepatitis c