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Early Detection and Curative Treatment of Hepatocellular Carcinoma: A Cost Effectiveness Analysis Based on Prospective French Cohort (ANRS CO12 CirVir and CHANGH)
POSTER PRESENTATIONS FRI-424 EARLY DETECTION AND CURATIVE TREATMENT OF HEPATOCELLULAR CARCINOMA: A COST EFFECTIVENESS ANALYSIS BASED ON PROSPECTIVE FRENCH COHORT (ANRS CO12 CIRVIR AND CHANGH) B. Cadier1–3, J. Bulsei1, P. Nahon4, O. Seror5, A. Laurent6, I. Rosa7, R. Layese8,9, Isabelle2, Durand-Zaleski1,2, K. Chevreul1–3. 1URC Eco Ile-de-France, AP-HP; 2ECEVE, INSERM; 3ECEVE, Paris 7 University, Paris; 4 Department of Hepatogastroenterology; 5Department of Radiology, Jean Verdier hospital, Bondy; 6Department of Hepatobiliary and Digestive Surgery; 7Department of Hepatology and Gastroenterology; 8 Department of Public Health, Henri Mondor Hospital; 9CEpiA (Clinical Epidemiology and Aging) Unit, Paris-Est Creteil university, Creteil, France E-mail: [email protected] Background and Aims: Hepatocellular carcinoma is the leading cause of death in patients with cirrhosis and its annual incidence varies between 3 and 6%. As the French guidelines on screening for hepatocellular carcinoma in patients with cirrhosis are not fully followed in current practice, the objective of this study was to estimate the cost-effectiveness of complying with these recommendations. Methods: The economic evaluation took the perspective of the healthcare system and compared screening as recommended by the guidelines (“gold standard monitoring”) to “real life monitoring”. We built a Markov model composed of three sub-models for each first line curative treatment: liver resection, radiofrequency ablation and liver transplantation taking into account the respective rates of implementation of each procedure in France. Patients entered the model in the “compensated cirrhosis” state with three months cycle length. Transition probabilities for both strategies were derived mainly from two prospective French cohorts (ANRS CO12 CirVir and CHANGH), while costs were computed using the French tariffs. Effectiveness was measured in life years gained. An incremental costeffectiveness ratio was calculated for a 10-year time horizon. We also performed one-way and probabilistic sensitivity analysis. Results: The 10-year overall survival was 76% in the gold standard monitoring group and 67% in the real life monitoring group. The cost difference between the two groups was €530 (€71,627 in the gold standard monitoring group versus €71,097 in the real life monitoring group) and survival increased by 0.37 year (7.18 years versus 6.81 years). The incremental cost-effectiveness ratio was €1,436/life year gained. In the sub-models it was €5,230/life year gained for a patient undergoing liver resection, €2,475/life year gained for a patient undergoing radiofrequency ablation and €19,319/life year gained for a patient undergoing liver transplantation. The probabilistic sensitivity analysis shows that whatever the sub-model, the gold standard monitoring strategy was always more effective and more expensive than the real life monitoring strategy (Figure).
Conclusions: Our results indicate that gold standard monitoring for patients with cirrhosis is cost-effective, due to a higher probability of benefiting from a curative treatment implementation leading to a higher survival. S466
FRI-425 SEROPREVALENCE OF HEPATITIS E VIRUS AMONG PORTUGUESE CHILDREN BORN IN THE 1990’S AND 2000’S: IS IT INCREASING? R.M.S. Oliveira1, S.S. Pereira1, J. Teixeira1, J. Abreu-Silva1, J.R. Mesquita2, M.S.J. Nascimento1. 1Faculdade de Farmácia da Universidade do Porto, Porto; 2Instituto Politécnico de Viseu, Viseu, Portugal E-mail: [email protected] Background and Aims: Autochthonous hepatitis E is considered today a substantial Public Health issue in industrialized countries. The majority of studies concerning HEV seroprevalence in these countries are focused on adult population, lacking documentation regarding the circulation of the virus among children. Moreover, reports from industrialized countries document higher seroprevalence rates in the last 10–20 years, yet to be known if this is the consequence of a true emergence or due to the use of more sensitive assays. The aim of the present work was to compare the prevalence of anti-HEV IgG in healthy children, born in the early 1990’s and in early 2000’s in the northern region of Portugal. The presence of anti-HEV IgM was also searched in order to detect silent HEV infections. Methods: Archived sera (N = 71) from healthy children born in early 1990’s and sera (N = 82) from healthy children born in early 2000’s were studied. Children of the two groups were matched by age (0–15 years-old) gender and region (northern region of Portugal). All serum samples were tested for anti-HEV IgG and IgM using an enzyme immunoassay (recomWell HEV IgG/IgM, 2012 version, Mikrogen, Germany). Samples positive for anti-HEV IgM were retested by immunodot assays (recomLine HEV IgG/IgM, Mikrogen, Germany). Differences were compared using a qui-square test. Results: Of the 71 children born in the 1990’s, 4 (5.6%) were found positive for anti-HEV IgG, while only 1 out of the 82 (1.2%) born in the 2000’s showed to have anti-HEV IgG. The difference between antiHEV IgG prevalence in these two groups was not statistically significant ( p = 0.125). Additionally, 2 samples of the 1990’s group tested positive for anti-HEV IgM by enzyme immunoassay and imunodot, suggesting recent hepatitis E virus infection. No anti-HEV IgM was detected in the 2000’s group. Conclusions: No significant difference was observed between agespecific antibody anti-HEV patterns obtained 10 years apart, suggesting that the seroprevalence of HEV in Portuguese children remained unaltered throughout the years. Moreover, the detection of acute hepatitis E infection in two healthy children shows the underdiagnosed reality of silent HEV infection among children. This study is part of the HEPeCONTROL project (60DT2), funded by the EEA Grants. FRI-426 ECONOMIC EVALUATION OF A COMMUNITY BASED DIAGNOSTIC PATHWAY TO SCREEN ADULTS FOR NON-ALCOHOLIC FATTY LIVER DISEASE L. Tanajewski1, R. Harris2, D.J. Harman2, G.P. Aithal2, T.R. Card2, G. Gkountouras1, V. Berdunov1, I.N. Guha2, R.A. Elliott1. 1Division of Social Research in Medicines and Health, School of Pharmacy, University of Nottingham; 2NIHR Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom E-mail: [email protected] Background and Aims: Current diagnostic algorithms for detecting non-alcoholic fatty liver disease (NAFLD) are based in secondary care and associated with considerable costs and late diagnosis. We have created an integrated community based pathway utilising transient elastography and a community hepatologist review, to stratify patients at risk of developing NAFLD. This study investigated the cost-effectiveness from an NHS England perspective of this innovative diagnostic pathway (IDP).
Journal of Hepatology 2016 vol. 64 | S425–S630
Conclusions: Our results indicate that gold standard monitoring for patients with cirrhosis is cost-effective, due to a higher probability of benefiting from a curative treatment implementation leading to a higher survival. S466
FRI-425 SEROPREVALENCE OF HEPATITIS E VIRUS AMONG PORTUGUESE CHILDREN BORN IN THE 1990’S AND 2000’S: IS IT INCREASING? R.M.S. Oliveira1, S.S. Pereira1, J. Teixeira1, J. Abreu-Silva1, J.R. Mesquita2, M.S.J. Nascimento1. 1Faculdade de Farmácia da Universidade do Porto, Porto; 2Instituto Politécnico de Viseu, Viseu, Portugal E-mail: [email protected] Background and Aims: Autochthonous hepatitis E is considered today a substantial Public Health issue in industrialized countries. The majority of studies concerning HEV seroprevalence in these countries are focused on adult population, lacking documentation regarding the circulation of the virus among children. Moreover, reports from industrialized countries document higher seroprevalence rates in the last 10–20 years, yet to be known if this is the consequence of a true emergence or due to the use of more sensitive assays. The aim of the present work was to compare the prevalence of anti-HEV IgG in healthy children, born in the early 1990’s and in early 2000’s in the northern region of Portugal. The presence of anti-HEV IgM was also searched in order to detect silent HEV infections. Methods: Archived sera (N = 71) from healthy children born in early 1990’s and sera (N = 82) from healthy children born in early 2000’s were studied. Children of the two groups were matched by age (0–15 years-old) gender and region (northern region of Portugal). All serum samples were tested for anti-HEV IgG and IgM using an enzyme immunoassay (recomWell HEV IgG/IgM, 2012 version, Mikrogen, Germany). Samples positive for anti-HEV IgM were retested by immunodot assays (recomLine HEV IgG/IgM, Mikrogen, Germany). Differences were compared using a qui-square test. Results: Of the 71 children born in the 1990’s, 4 (5.6%) were found positive for anti-HEV IgG, while only 1 out of the 82 (1.2%) born in the 2000’s showed to have anti-HEV IgG. The difference between antiHEV IgG prevalence in these two groups was not statistically significant ( p = 0.125). Additionally, 2 samples of the 1990’s group tested positive for anti-HEV IgM by enzyme immunoassay and imunodot, suggesting recent hepatitis E virus infection. No anti-HEV IgM was detected in the 2000’s group. Conclusions: No significant difference was observed between agespecific antibody anti-HEV patterns obtained 10 years apart, suggesting that the seroprevalence of HEV in Portuguese children remained unaltered throughout the years. Moreover, the detection of acute hepatitis E infection in two healthy children shows the underdiagnosed reality of silent HEV infection among children. This study is part of the HEPeCONTROL project (60DT2), funded by the EEA Grants. FRI-426 ECONOMIC EVALUATION OF A COMMUNITY BASED DIAGNOSTIC PATHWAY TO SCREEN ADULTS FOR NON-ALCOHOLIC FATTY LIVER DISEASE L. Tanajewski1, R. Harris2, D.J. Harman2, G.P. Aithal2, T.R. Card2, G. Gkountouras1, V. Berdunov1, I.N. Guha2, R.A. Elliott1. 1Division of Social Research in Medicines and Health, School of Pharmacy, University of Nottingham; 2NIHR Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom E-mail: [email protected] Background and Aims: Current diagnostic algorithms for detecting non-alcoholic fatty liver disease (NAFLD) are based in secondary care and associated with considerable costs and late diagnosis. We have created an integrated community based pathway utilising transient elastography and a community hepatologist review, to stratify patients at risk of developing NAFLD. This study investigated the cost-effectiveness from an NHS England perspective of this innovative diagnostic pathway (IDP).
Journal of Hepatology 2016 vol. 64 | S425–S630