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DOI: 10.1055/a-1989-1971
Costs of a structured early detection program for advanced liver fibrosis and cirrhosis: insights on the “plus” of Check-up 35+
Kosten eines populationsbasierten Screenings auf Leberfibrose und Zirrhose: Erkenntnisse zum „Plus“ eines Check-up 35+Supported by: Gemeinsamer Bundesausschuss 01NVF16026
Abstract
Background The implementation of an early detection program for liver cirrhosis in a general population has been discussed for some time. Recently, the effectiveness of a structured screening procedure, called SEAL (Structured Early detection of Asymptomatic Liver cirrhosis), using liver function tests (AST and ALT) and APRI to early detect advanced fibrosis and cirrhosis in participants of the German “Check-up 35” was investigated.
Methods This study identifies the expected diagnostic costs of SEAL in routine care and their drivers and reports on prevailing CLD etiologies in this check-up population. The analysis is based on theoretical unit costs, as well as on the empirical billing and diagnostic data of SEAL participants.
Results Screening costs are mainly driven by liver biopsies, which are performed in a final step in some patients. Depending on the assumed biopsy rates and the diagnostic procedure, the average diagnostic costs are between EUR 5.99 and 13.74 per Check-up 35 participant and between EUR 1,577.06 and 3,620.52 per patient diagnosed with fibrosis/cirrhosis (F3/F4). The prevailing underlying etiology in 60% of cases is non-alcoholic fatty liver disease.
Discussion A liver screening following the SEAL algorithm could be performed at moderate costs. Screening costs in routine care depend on actual biopsy rates and procedures, attendance rates at liver specialists, and the prevalence of fibrosis in the Check-up 35 population. The test for viral hepatitis newly introduced to Check-up 35 as once-in-a-lifetime part of Check-up 35 is no alternative to SEAL.
Zusammenfassung
Hintergrund Die Einführung eines strukturierten Früherkennungsprogramms für Leberzirrhose in der Allgemeinbevölkerung wird bereits seit einiger Zeit diskutiert. Kürzlich wurde die Effektivität eines spezifischen Screenings mittels Leberwerten (ALT, AST) und APRI bei Teilnehmern des „Check-up 35“ – genannt SEAL (Strukturierte Früh-Erkennung einer Asymptomatischen Leberzirrhose) – untersucht.
Methoden Diese Studie ermittelt die zu erwartenden Diagnosekosten bei Einführung von SEAL in die Regelversorgung, die Kostentreiber sowie die vorherrschenden Ätiologien in dieser Check-up-Population. Sie basiert auf theoretischen Stückkosten sowie empirischen Abrechnungs- und Diagnosedaten von SEAL-Teilnehmern.
Ergebnisse Die Kosten des Screenings werden insbesondere durch Leberbiopsien einiger Patienten im letzten Schritt getrieben. In Abhängigkeit der Biopsierate und -methode liegen die durchschnittlichen Diagnosekosten pro Teilnehmer des Check-up 35 zwischen 5,99 und 13,74 EUR bzw. zwischen 1.577,06 und 3.620,52 EUR pro diagnostizierter Fibrose/Zirrhose (F3 / F4). Die häufigste Grunderkrankung mit 60% der Fälle ist die nichtalkoholische Fettleber.
Diskussion Ein SEAL-Leberscreening könnte zu moderaten Kosten durchgeführt werden. Die Screeningkosten hängen jedoch von den tatsächlichen Biopsieraten und -methoden, Wahrnehmungsraten von Facharztterminen und der Fibroseprävalenz in der Check-up 35-Population ab. Der neu in den Check-up 35 eingeführte (einmalige) Test auf virale Hepatitis stellt keine Alternative zu SEAL dar.
Schlüsselwörter
chronische Lebererkrankung - Gesundheitsökonomie - Kostenanalyse - Leberfibrose - nicht-invasive Tests - Screening - ZirrhoseKeywords
chronic liver disease - cirrhosis - cost analysis - health economics - hepatic fibrosis - non-invasive tests - screeningPublication History
Received: 09 May 2022
Accepted after revision: 23 November 2022
Article published online:
09 January 2023
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