LiverMultiScan as an alternative to liver biopsy to monitor autoimmune hepatitis in the National Health Service in England: an economic evaluation

Background Autoimmune hepatitis (AIH) is a rare chronic progressive liver disease, managed with corticosteroids and immunosuppressants and monitored using a combination of liver biochemistry and histology. Liver biopsy (gold standard) is invasive, costly and has risk of complications. Non-invasive imaging using multiparametric magnetic resonance (mpMR) can detect the presence and extent of hepatic fibroinflammation in a risk-free manner. Objective To conduct early economic modelling to assess the affordability of using mpMR as an alternative to liver biopsy. Methods Medical test costs associated with following 100 patients over a 5-year time horizon were assessed from a National Health Service payor perspective using tariff costs and average biopsy-related adverse events costs. Sensitivity analyses modelling the cost consequences of increasing the frequency of mpMR monitoring within the fixed cost of liver biopsy were performed. Results Per 100 moderate/severe AIH patients receiving an annual mpMR scan (in place of biopsy), early economic modelling showed minimum cost savings of 232333. Per 100 mild/moderate AIH patients receiving three mpMR scans over 5 years estimated minimum cost savings were 139400. One-way sensitivity analyses showed increasing the frequency of mpMR scans from 5 to 10 over 5 years in moderate/severe AIH patients results in a cost saving of 121926.20 pound. In patients with mild/moderate AIH, an increase from 3 to 6 mpMR scans over 5 years could save 73155.72 pound. In a minimalistic approach, the use of 5 mpMR scans was still cost saving (5770.48) pound if they were to replace two biopsies over the 5-year period for all patients with moderate/severe or mild/moderate AIH. Conclusions Integration of mpMR scans in AIH patient pathways leads to significant cost savings when liver biopsy frequency is either reduced or eliminated, in addition to improved patient experience and clinician acceptability as well as providing detailed phenotyping to improve patient outcomes.