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Cited by 39Liver Disease Diagnosis and TreatmentHealth Systems, Economic Evaluations, Quality of LifeHealthcare cost, quality, practices

The DOI matches its Crossref record; 34 of the 34 references it cites were found in a registry or an index.

Cost-effectiveness analysis of ultrasonography screening for nonalcoholic fatty liver disease in metabolic syndrome patients

Open access
Phisalprapa, Pochamana, Supakankunti, Siripen, Charatcharoenwitthaya, Phunchai, Apisarnthanarak, Piyaporn, Charoensak, Aphinya, Washirasaksiri, Chaiwat, Srivanichakorn, Weerachai, Chaiyakunapruk, Nathorn·2017·Medicine
DOI 10.1097/md.0000000000006585PMC PMC5413221
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Abstract

BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) can be diagnosed early by noninvasive ultrasonography; however, the cost-effectiveness of ultrasonography screening with intensive weight reduction program in metabolic syndrome patients is not clear. This study aims to estimate economic and clinical outcomes of ultrasonography in Thailand. METHODS: Cost-effectiveness analysis used decision tree and Markov models to estimate lifetime costs and health benefits from societal perspective, based on a cohort of 509 metabolic syndrome patients in Thailand. Data were obtained from published literatures and Thai database. Results were reported as incremental cost-effectiveness ratios (ICERs) in 2014 US dollars (USD) per quality-adjusted life year (QALY) gained with discount rate of 3%. Sensitivity analyses were performed to assess the influence of parameter uncertainty on the results. RESULTS: The ICER of ultrasonography screening of 50-year-old metabolic syndrome patients with intensive weight reduction program was 958 USD/QALY gained when compared with no screening. The probability of being cost-effective was 67% using willingness-to-pay threshold in Thailand (4848 USD/QALY gained). Screening before 45 years was cost saving while screening at 45 to 64 years was cost-effective. CONCLUSIONS: For patients with metabolic syndromes, ultrasonography screening for NAFLD with intensive weight reduction program is a cost-effective program in Thailand. Study can be used as part of evidence-informed decision making. TRANSLATIONAL IMPACTS: Findings could contribute to changes of NAFLD diagnosis practice in settings where economic evidence is used as part of decision-making process. Furthermore, study design, model structure, and input parameters could also be used for future research addressing similar questions.

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Crossref · 10.1097/md.0000000000006585

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Figure 1 Decision tree and Markov models. A decision tree was constructed to divide patients into 2 groups; screening with intensive weight reduction program and no screening groups. In Markov models, patients could remain in the same state or move to other states.
Figure 1 Decision tree and Markov models. A decision tree was constructed to divide patients into 2 groups; screening with intensive weight reduction program and no screening groups. In Markov models, patients could remain in the same state or move to other states.CC BY-ND · PubMed Central
Figure 2 Tornado diagram of base-case analysis. This model illustrated the result of 1-way sensitivity analyses that were performed to study the effects of altering uncertainty parameters within the 95% CI ranges including all clinical effects, costs, utilities, and discounting rate on the ICER in the model. ICER = incremental cost-effectiveness ratio.
Figure 2 Tornado diagram of base-case analysis. This model illustrated the result of 1-way sensitivity analyses that were performed to study the effects of altering uncertainty parameters within the 95% CI ranges including all clinical effects, costs, utilities, and discounting rate on the ICER in the model. ICER = incremental cost-effectiveness ratio.CC BY-ND · PubMed Central
Figure 3 Multivariate probabilistic sensitivity analysis. The analysis was based on 1000 Monte Carlo simulations (A) cost-effectiveness plane, (B) cost-effectiveness acceptability curve.
Figure 3 Multivariate probabilistic sensitivity analysis. The analysis was based on 1000 Monte Carlo simulations (A) cost-effectiveness plane, (B) cost-effectiveness acceptability curve.CC BY-ND · PubMed Central

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Metadata

Authors
Phisalprapa, P., Supakankunti, S., Charatcharoenwitthaya, P., Apisarnthanarak, P., Charoensak, A., Washirasaksiri, C., Srivanichakorn, W., & Chaiyakunapruk, N.
Affiliations
  • Monash University Malaysia (MY)
  • Chulalongkorn University (TH)
  • Siriraj Hospital (TH)
Corresponding author
Chaiyakunapruk, Nathorn
ORCID
Venue
Medicine
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2017-04
Volume
96
Issue
17
Pages
e6585
ISSN
0025-7974 (ISSN-L)
DOI
10.1097/md.0000000000006585
PMC
PMC5413221
OpenAlex
W2602200833
Cited by
39
References
34
Citations by year
2026: 5 · 2025: 6 · 2024: 3 · 2023: 3 · 2022: 4 · 2021: 7 · 2020: 4 · 2019: 1 · 2018: 4 · 2017: 2
FWCI
2.36
Type
journal article
Language
en
Open access
Licence
cc-by-nd
Locations
  • Medicine (publishedVersion, cc-by-nd)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by-nd)
  • PubMed Central (publishedVersion, cc-by-nd)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Hepatology › Liver Disease Diagnosis and Treatment
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
  • Health Sciences › Health Professions › General Health Professions › Healthcare cost, quality, practices
Keywords
non-alcoholic fatty liver disease, metabolic syndrome, ultrasound screening, cost-effectiveness, quality-adjusted life years, screening age thresholds, Thailand
MeSH terms
Cost-Benefit Analysis, Decision Trees, Humans, Markov Chains, Middle Aged, Oxadiazoles, Sensitivity and Specificity, Thailand, Ultrasonography, Cohort Studies, Multivariate Analysis, Treatment Outcome, Models, Economic, Quality-Adjusted Life Years, Metabolic Syndrome, Weight Reduction Programs, Non-alcoholic Fatty Liver Disease

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