{"doi":"10.1093/cid/ciae485","title":"Clinical- and Cost-Effectiveness of Liver Disease Staging in Hepatitis C Virus Infection: A Microsimulation Study","abstract":"BACKGROUND: Liver disease assessment is a key aspect of chronic hepatitis C virus (HCV) infection pre-treatment evaluation but guidelines differ on the optimal testing modality given trade-offs in availability and accuracy. We compared clinical outcomes and cost-effectiveness of common fibrosis staging strategies. METHODS: We simulated adults with chronic HCV receiving care at US health centers through a lifetime microsimulation across five strategies: (1) no staging or treatment (comparator), (2) indirect serum biomarker testing (Fibrosis-4 index [FIB-4]) only, (3) transient elastography (TE) only, (4) staged approach: FIB-4 for all, TE only for intermediate FIB-4 scores (1.45-3.25), and (5) both tests for all. Outcomes included infections cured, cirrhosis cases, liver-related deaths, costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs). We used literature-informed loss to follow-up (LTFU) rates and 2021 Medicaid perspective and costs. RESULTS: FIB-4 alone generated the best clinical outcomes: 87.7% cured, 8.7% developed cirrhosis, and 4.6% had liver-related deaths. TE strategies cured 58.5%-76.6%, 16.8%-29.4% developed cirrhosis, and 11.6%-22.6% had liver-related deaths. All TE strategies yielded worse clinical outcomes at higher costs per QALY than FIB-4 only, which had an ICER of $12 869 per QALY gained compared with no staging or treatment. LTFU drove these findings: TE strategies were only cost-effective with no LTFU. In a point-of-care HCV test-and-treat scenario, treatment without any staging was most clinically and cost-effective. CONCLUSIONS: FIB-4 staging alone resulted in optimal clinical outcomes and was cost-effective. Treatment for chronic HCV should not be delayed while awaiting fibrosis staging with TE.","journal":"Clinical Infectious Diseases","year":2024,"id":482190,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":1,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9401,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2024-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1287471,"name":"Sarah Munroe","orcid":"0009-0009-5591-1454","position":1,"is_corresponding":false},{"id":681676,"name":"Lynn E. Taylor","orcid":"0000-0002-0472-8125","position":2,"is_corresponding":false},{"id":1322816,"name":"Patrick Duryea","orcid":null,"position":3,"is_corresponding":false},{"id":1322817,"name":"Benjamin Buzzee","orcid":null,"position":4,"is_corresponding":false},{"id":1322818,"name":"Tannishtha Pramanick","orcid":null,"position":5,"is_corresponding":false},{"id":28335,"name":"Jordan J. Feld","orcid":"0000-0003-2640-2211","position":6,"is_corresponding":false},{"id":1322819,"name":"Dimitri Baptiste","orcid":null,"position":7,"is_corresponding":false},{"id":1175530,"name":"Matthew Carroll","orcid":"0009-0009-3359-2675","position":8,"is_corresponding":false},{"id":1322471,"name":"Laurent Castéra","orcid":"0000-0002-6715-8588","position":9,"is_corresponding":false},{"id":325248,"name":"Richard K. Sterling","orcid":"0000-0002-8637-2475","position":10,"is_corresponding":false},{"id":1322820,"name":"Aurielle Thomas","orcid":null,"position":11,"is_corresponding":false},{"id":390871,"name":"Philip A. Chan","orcid":"0000-0003-0964-5895","position":12,"is_corresponding":false},{"id":312536,"name":"Benjamin P. Linas","orcid":"0000-0002-9781-9690","position":13,"is_corresponding":false},{"id":471065,"name":"Rachel Epstein","orcid":"0000-0003-2831-8865","position":0,"is_corresponding":true}],"reference_count":67,"raw_metadata":null,"created_at":"2026-07-19T02:07:14.349221Z","pmid":"39535186","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}