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Summary   We compared the cost‐effectiveness of various noninvasive tests ( NIT s) in patients with chronic hepatitis B and elevated transaminases and/or viral load who would normally undergo liver biopsy to inform treatment decisions. We searched various databases until April 2012. We conducted a systematic review and meta‐analysis to calculate the diagnostic accuracy of various  NIT s using a bivariate random‐effects model. We constructed a probabilistic decision analytical model to estimate health care costs and outcomes quality‐adjusted‐life‐years ( QALY s) using data from the meta‐analysis, literature, and national  UK  data. We compared the cost‐effectiveness of four decision‐making strategies: testing with  NIT s and treating patients with fibrosis stage ≥F2, testing with liver biopsy and treating patients with ≥F2, treat none (watchful waiting) and treat all irrespective of fibrosis. Treating all patients without prior fibrosis assessment had an incremental cost‐effectiveness ratio ( ICER ) of £28 137 per additional  QALY  gained for  HB eAg‐negative patients. For  HB eAg‐positive patients, using Fibroscan was the most cost‐effective option with an  ICER  of £23 345. The base case results remained robust in the majority of sensitivity analyses, but were sensitive to changes in the ≥F2 prevalence and the benefit of treatment in patients with F0–F1. For  HB eAg‐negative patients, strategies excluding  NIT s were the most cost‐effective: treating all patients regardless of fibrosis level if the high cost‐effectiveness threshold of £30 000 is accepted; watchful waiting if not. For  HB eAg‐positive patients, using Fibroscan to identify and treat those with ≥F2 was the most cost‐effective option.

journal of viral hepatitis

Cost‐effectiveness of noninvasive liver fibrosis tests for treatment decisions in patients with chronic hepatitis B in the  UK : systematic review and economic evaluation