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.
|Stage||n (%)||Stage||n (%)|
|F1||10 (50)||A0||3 (15)|
|F2||7 (35)||A1||7 (35)|
|F3||1 (5)||A2||8 (40)|
|F4||2 (10)||A3||2 (10)|
|Concur n(%)||3 (17)||10 (55)|
|Underestimate n(%)||2 (11)||3 (17)|
|Overestimate n(%)||13 (72)||5 (28)|