The cost-effectiveness of non-invasive liver tests for the detection of liver fibrosis in patients with suspected alcohol-related liver disease

Alcohol is the most common cause of liver disease in the Western world. Alcohol produces a spectrum of liver injury which includes fatty liver, alcoholic hepatitis, cirrhosis and hepatocellular carcinoma. Although patients with cirrhosis may remain symptom-free for several years, once complications develop survival is adversely affected. Currently, the reference standard for assessing liver damage is histological examination of a liver biopsy specimen: this allows, first, confirmation of a diagnosis of ALD; second, accurate staging of the degree of liver injury and third, exclusion of other or additional liver pathologies. This information is then used to determine prognosis and inform treatment decisions. However, liver biopsy is associated with morbidity and mortality. In view of these difficulties, interest has arisen in the use of surrogate markers to assess the severity of liver injury. As liver fibrosis represents the final common outcome of chronic liver injury and is often progressive, evolving to cirrhosis, most of the non-invasive markers are in effect markers of this process. Much of the work in this field has centred on the evaluation of patients with chronic hepatitis C; there is little information on the use and potential cost-effectiveness of these markers in patients with ALD. The work undertaken evaluate the costeffectiveness compared with liver biopsy, of four non-invasive liver tests (NILTs) specified by NICE, FibroTest, FibroMAX, the ELF test and FibroScan