[1970] Efficacy and Cost of Using FibroSURE To Evaluate Hepatic Fibrosis in a Veterans Administration Patient Population: A Pilot Study

Erica F Clayton, David Kaplan, Kyong-mi Chang, Jorge Sepulveda, Laura Chandler, Nirag Jhala, Darshana Jhala. Hospital of the University of Pennsylvania, Philadelphia, PA; Veterans Administration Medical Center, Philadelphia, PA

Background: Liver biopsy is the gold standard for monitoring disease progression in patients with chronic liver disease. FibroSURE, a commercially available test which uses serum biomarkers to predict fibrosis and activity, is a non-invasive alternative to liver biopsy. We study the use of FibroSURE at a Veterans Administration Medical Center and assess its diagnostic efficacy and cost-effectiveness.
Design: We retrospectively identified patients who underwent both FibroSURE and liver biopsy at our institution in a one-year period. The original liver biopsy slides were independently re-reviewed by two pathologists and assigned METAVIR scores. METAVIR scores were then compared with the patients' FibroSURE results. The institutional costs per test were obtained.
Results: Of the 796 patients with FibroSURE results during the study period, 22 had concurrent FibroSURE testing and liver biopsy. Twenty biopsies were available for review. All 20 patients (19 males, 1 female, mean age 56.65 years, range 40-63 years) had a history of Hepatitis C. All 20 liver biopsies yielded diagnostic tissue; results below.

METAVIR score determined by liver biopsy (n=20)
FibrosisActivity
Stagen (%)Stagen (%)
F110 (50)A03 (15)
F27 (35)A17 (35)
F31 (5)A28 (40)
F42 (10)A32 (10)


Two (10%) of the 20 patients had non-diagnostic FibroSURE results. None of the patients had complete concordance between FibroSURE and liver biopsy for both fibrosis and activity scores. Relative performance of FibroSURE to liver biopsy is shown.

Comparison of FibroSURE Results to Liver Biopsy
 FibrosisActivity
Concur n(%)3 (17)10 (55)
Underestimate n(%)2 (11)3 (17)
Overestimate n(%)13 (72)5 (28)


The institutional cost of liver biopsy was $289.43, plus $65.99 for pathology interpretation. The institutional cost of FibroSURE was $105.
Conclusions: Preliminary comparisons with liver biopsy show FibroSURE may overestimate fibrosis and activity in patients with Hepatitis C, and suggest that in this population, FibroSURE is more accurate in assessing activity than fibrosis. Our study also reveals a greater than three-fold institutional cost difference between liver biopsy and FibroSURE. Expanding the study population and cost-benefit analysis will allow us to determine strategies for controlling health care costs while maintaining quality of care for Hepatitis C patients in our institution.
Category: Quality Assurance

Tuesday, March 5, 2013 9:30 AM

Poster Session III # 298, Tuesday Morning

 

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