| Title: |
Evaluating a population-based screening programme for early detection of liver fibrosis and cirrhosis in primary care in Germany: a cost assessment study |
| Authors: |
Ortner, Julia; Ewijk, Reyn van; Velthuis, Louis; Labenz, Christian; Arslanow, Anita; Nguyen-Tat, Marc; Wörns, Marcus-Alexander; Reichert, Matthias Christian; Farin-Glattacker, E.; Binder, Harald; Fichtner, Urs Alexander; Graf, Erika; Stelzer, Dominikus; Galle, Peter R.; Lammert, Frank |
| Source: |
BMJ open. - 15, 9 (2025) , e090442, ISSN: 2044-6055 |
| Publication Year: |
2025 |
| Collection: |
University of Freiburg: FreiDok |
| Description: |
Objectives Structured Early detection of Asymptomatic Liver fibrosis and cirrhosis (SEAL) is a population-based screening programme using non-invasive tests for the early detection of liver fibrosis. This study evaluates the cost implications if the SEAL programme were to be implemented in routine care in Germany. Design This study models cost differences with and without the SEAL screening programme. We regress costs of care on patient characteristics (age, comorbidities, sex, liver diseases, liver cancer and liver fibrosis and cirrhosis (LCI) stage) using statutory health insurance (SHI) data from routine care patients with LCI (n=4177). Based on these results, we predict per-patient costs for the patients newly diagnosed with LCI by SEAL (n=45). Costs with and without screening are estimated using patient age and LCI stage distributions from either SEAL or routine care. Setting SEAL was conducted in two German states. Initial screening was performed by patients’ primary care physicians. Participants Individuals insured by SHI without a prior diagnosis of LCI, eligible for Check-up 35, a general health check-up programme primarily targeting adults aged 35 and older, conducted by primary care physicians. Interventions Screening via aspartate aminotransferase to platelet ratio index in primary care, for further evaluation serological diagnostics and ultrasound examinations in secondary care and specific assessment for definite diagnosis including transient elastography and liver biopsy for selected cases in tertiary care. Primary and secondary outcome measures Primary outcome measures: expected 5-year cost changes for SEAL patients diagnosed with fibrosis or cirrhosis compared to costs without a screening programme. Secondary outcome measures: case mix of leading chronic liver disease and LCI stages among patients diagnosed with advanced fibrosis or cirrhosis in SEAL versus routine care without screening. Results Screening leads to fewer decompensated cases at initial diagnosis (4.6% in SEAL vs 22.8% in routine ... |
| Document Type: |
article in journal/newspaper |
| File Description: |
pdf |
| Language: |
English |
| Relation: |
https://freidok.uni-freiburg.de/data/271682 |
| DOI: |
10.1136/bmjopen-2024-090442 |
| Availability: |
https://freidok.uni-freiburg.de/data/271682; https://nbn-resolving.org/urn:nbn:de:bsz:25-freidok-2716825; https://doi.org/10.1136/bmjopen-2024-090442; https://freidok.uni-freiburg.de/dnb/download/271682 |
| Rights: |
free |
| Accession Number: |
edsbas.C7197A04 |
| Database: |
BASE |